Emergency first aid. In case of ineffectiveness of the above measures
Emergency conditions(accidents) - incidents, as a result of which harm is done to human health or there is a threat to his life. An emergency is characterized by suddenness: it can happen to anyone, at any time and in any place.
People injured in an accident need immediate medical attention. If there is a doctor, paramedic, or nurse turn to them for first aid. Otherwise, help should be provided by people who are close to the victim.
The severity of the consequences of an emergency, and sometimes the life of the victim, depends on the timeliness and correctness of actions to provide emergency medical care, so each person must have the skills to provide first aid in emergency conditions.
There are the following types of emergency conditions:
thermal injury;
poisoning;
Bites of poisonous animals;
Attacks of diseases;
Consequences of natural disasters;
Radiation damage, etc.
The set of measures required for victims in each type of emergency has a number of features that must be taken into account when providing assistance to them.
4.2. First aid for sun, heat stroke and fumes
Sunstroke called a lesion resulting from long-term exposure to sunlight on an unprotected head. Sunstroke can also be obtained with a long stay on the street on a clear day without a hat.
Heatstroke- this is excessive overheating of the whole organism as a whole. Heat stroke can also happen in cloudy, hot, windless weather - with long and hard physical work, long and difficult transitions, etc. Heat stroke is more likely when a person is not physically prepared enough and is very tired and thirsty.
Symptoms of sun and heat stroke are:
Cardiopalmus;
Redness, and then blanching of the skin;
violation of coordination;
Headache;
Noise in ears;
Dizziness;
Great weakness and lethargy;
Decrease in the intensity of the pulse and breathing;
Nausea, vomiting;
Nose bleed;
Sometimes convulsions and fainting.
Providing first aid in case of sun and thermal shock should begin with the transportation of the victim to a place protected from heat exposure. In this case, it is necessary to lay the victim in such a way that his head is higher than the body. After that, the victim needs to provide free access to oxygen, loosen his clothes. To cool the skin, you can wipe the victim with water, cool the head with a cold compress. The victim should be given a cold drink. In severe cases, artificial respiration is necessary.
Fainting- This is a short-term loss of consciousness due to insufficient blood flow to the brain. Fainting can occur from severe fright, excitement, great fatigue, as well as from significant blood loss and a number of other reasons.
When fainting, a person loses consciousness, his face turns pale and covered with cold sweat, the pulse is barely palpable, breathing slows down and is often difficult to detect.
First aid for fainting comes down to improving the blood supply to the brain. For this, the victim is laid so that his head is lower than the body, and his legs and arms are somewhat raised. The victim's clothing must be loosened, his face is sprinkled with water.
It is necessary to ensure the flow of fresh air (open the window, fan the victim). To excite the breath, you can give a sniff of ammonia, and to enhance the activity of the heart, when the patient regains consciousness, give hot strong tea or coffee.
frenzy- poisoning of a person with carbon monoxide (CO). Carbon monoxide is formed when fuel burns without an adequate supply of oxygen. Carbon monoxide poisoning is unnoticeable because the gas is odorless. Symptoms of carbon monoxide poisoning include:
General weakness;
Headache;
Dizziness;
Drowsiness;
Nausea, then vomiting.
In severe poisoning, there are violations of cardiac activity and respiration. If the injured person is not helped, death may occur.
First aid for fumes comes down to the following. First of all, the victim must be removed from the zone of carbon monoxide or ventilate the room. Then you need to apply a cold compress to the head of the victim and let him smell the cotton wool moistened with ammonia. To improve cardiac activity, the victim is given a hot drink (strong tea or coffee). Heating pads are applied to the legs and arms or mustard plasters are placed. When fainting, give artificial respiration. After that, you should immediately seek medical help.
4.3. First aid for burns, frostbite and freezing
Burn- this is thermal damage to the integument of the body caused by contact with hot objects or reagents. A burn is dangerous because, under the influence of high temperature, the living protein of the body coagulates, i.e., living human tissue dies. The skin is designed to protect tissues from overheating, however, with prolonged action of the damaging factor, not only the skin suffers from a burn,
but also tissues, internal organs, bones.
Burns can be classified according to a number of criteria:
According to the source: burns by fire, hot objects, hot liquids, alkalis, acids;
According to the degree of damage: burns of the first, second and third degree;
By the size of the affected surface (as a percentage of the body surface).
With a first-degree burn, the burnt area turns slightly red, swells, and a slight burning sensation is felt. Such a burn heals within 2-3 days. A second-degree burn causes redness and swelling of the skin, blisters filled with a yellowish liquid appear on the burned area. The burn heals in 1 or 2 weeks. A third-degree burn is accompanied by necrosis of the skin, underlying muscles, and sometimes bone.
The danger of a burn depends not only on its degree, but also on the size of the damaged surface. Even a first-degree burn, if it covers half the surface of the entire body, is considered a serious disease. In this case, the victim experiences a headache, vomiting, diarrhea appear. The body temperature rises. These symptoms are caused by a general poisoning of the body due to the decay and decomposition of dead skin and tissues. With large burn surfaces, when the body is not able to remove all decay products, kidney failure may occur.
Second and third degree burns, if they affect a significant part of the body, can be fatal.
First health care with burns of the first and second degree, it is limited to applying a lotion of alcohol, vodka or a 1-2% solution of potassium permanganate (half a teaspoon to a glass of water) on the burnt place. In no case should you pierce the bubbles formed as a result of a burn.
If a third-degree burn occurs, a dry sterile bandage should be applied to the burnt area. In this case, it is necessary to remove the remnants of clothing from the burnt place. These actions must be performed very carefully: first, the clothes are cut off around the affected area, then the affected area is soaked with a solution of alcohol or potassium permanganate and only then removed.
With a burn acid the affected surface must be immediately washed with running water or a 1-2% soda solution (half a teaspoon per glass of water). After that, the burn is sprinkled with crushed chalk, magnesia or tooth powder.
When exposed to particularly strong acids (for example, sulfuric), washing with water or aqueous solutions can cause secondary burns. In this case, the wound should be treated with vegetable oil.
For burns caustic alkali the affected area is washed with running water or a weak solution of acid (acetic, citric).
frostbite- this is a thermal damage to the skin, caused by their strong cooling. Unprotected areas of the body are most susceptible to this type of thermal damage: ears, nose, cheeks, fingers and toes. The likelihood of frostbite increases when wearing tight shoes, dirty or wet clothes, with general exhaustion of the body, anemia.
There are four degrees of frostbite:
- I degree, in which the affected area turns pale and loses sensitivity. When the effect of cold ceases, the frostbite becomes bluish-red in color, becomes painful and swollen, and itching often appears;
- II degree, in which blisters appear on the frostbitten area after warming, the skin around the blisters has a bluish-red color;
- III degree, at which necrosis of the skin occurs. Over time, the skin dries out, a wound forms under it;
- IV degree, in which necrosis can spread to the tissues lying under the skin.
First aid for frostbite is to restore blood circulation in the affected area. The affected area is wiped with alcohol or vodka, lightly lubricated with petroleum jelly or unsalted fat and carefully rubbed with cotton or gauze so as not to damage the skin. You should not rub the frostbitten area with snow, as ice particles come across in the snow, which can damage the skin and facilitate the penetration of microbes.
Burns and blisters resulting from frostbite are similar to burns from exposure elevated temperature. Accordingly, the steps described above are repeated.
In the cold season, in severe frosts and snowstorms, it is possible general freezing of the body. Its first symptom is chilliness. Then a person develops fatigue, drowsiness, the skin turns pale, the nose and lips are cyanotic, breathing is barely noticeable, the activity of the heart gradually weakens, and an unconscious state is also possible.
First aid in this case comes down to warming the person and restoring his blood circulation. To do this, you need to bring it into a warm room, make, if possible, a warm bath and easily rub the frostbitten limbs with your hands from the periphery to the center until the body becomes soft and flexible. Then the victim must be put to bed, covered warmly, given hot tea or coffee to drink and a doctor called.
However, it should be taken into account that with a long stay in cold air or in cold water, all human vessels narrow. And then, due to a sharp heating of the body, blood can hit the vessels of the brain, which is fraught with a stroke. Therefore, heating a person must be done gradually.
4.4. First aid for food poisoning
Poisoning of the body can be caused by eating various poor-quality products: stale meat, jelly, sausages, fish, lactic acid products, canned food. It is also possible poisoning due to the use of inedible greens, wild berries, mushrooms.
The main symptoms of poisoning are:
General weakness;
Headache;
Dizziness;
Abdominal pain;
Nausea, sometimes vomiting.
In severe cases of poisoning, loss of consciousness, weakening of cardiac activity and respiration are possible, in the most severe cases - death.
First aid for poisoning begins with the removal of poisoned food from the stomach of the victim. To do this, they induce vomiting in him: give him 5-6 glasses of warm salted or soda water to drink, or insert two fingers deep into the throat and press on the root of the tongue. This cleansing of the stomach must be repeated several times. If the victim is unconscious, his head must be turned to the side so that the vomit does not fall into Airways.
In case of poisoning with strong acid or alkali, it is impossible to induce vomiting. In such cases, the victim should be given oatmeal or flax decoction, starch, raw eggs, sunflower or butter.
The poisoned person should not be allowed to fall asleep. To eliminate drowsiness, you need to spray the victim cold water or drink strong tea. In case of convulsions, the body is warmed with heating pads. After providing first aid, the poisoned person must be taken to the doctor.
4.5. First aid for poisoning
TO toxic substances(OS) refers to chemical compounds capable of infecting unprotected people and animals, leading to their death or incapacitating them. The action of agents can be based on ingestion through the respiratory organs (inhalation exposure), penetration through the skin and mucous membranes (resorption), or through the gastrointestinal tract when contaminated food and water are consumed. Poisonous substances act in drop-liquid form, in the form of aerosols, vapor or gas.
As a rule, agents are an integral part of chemical weapons. Chemical weapons are understood as military means, the damaging effect of which is based on the toxic effects of OM.
Poisonous substances that are part of chemical weapons have a number of features. They are capable of causing massive damage to people and animals in a short time, destroying plants, infecting large volumes of surface air, which leads to the defeat of people on the ground and uncovered people. For a long time, they can retain their damaging effect. The delivery of such agents to their destinations is carried out in several ways: with the help of chemical bombs, aircraft pouring devices, aerosol generators, rockets, rocket and artillery shells and mines.
First medical aid in case of OS damage should be carried out in the order of self-help and mutual assistance or specialized services. When providing first aid, you must:
1) immediately put on a gas mask on the victim (or replace the damaged gas mask with a serviceable one) to stop the effect of the damaging factor on the respiratory system;
2) quickly introduce an antidote (specific drug) to the victim using a syringe tube;
3) sanitize all exposed skin areas of the victim with a special liquid from an individual anti-chemical package.
The syringe tube consists of a polyethylene body, on which a cannula with an injection needle is screwed. The needle is sterile, it is protected from contamination by a cap tightly put on the cannula. The body of the syringe tube is filled with an antidote or other drug and hermetically sealed.
To administer the drug using a syringe tube, you must perform the following steps.
1. Using the thumb and forefinger of the left hand, grasp the cannula, and with the right hand support the body, then turn the body clockwise until it stops.
2. Make sure there is medicine in the tube (to do this, press the tube without removing the cap).
3. Remove the cap from the syringe, while turning it a little; squeeze the air out of the tube by pressing it until a drop of liquid appears at the tip of the needle.
4. Sharply (with a stabbing motion) insert the needle under the skin or into the muscle, after which all the liquid contained in it is squeezed out of the tube.
5. Without opening your fingers on the tube, remove the needle.
When administering an antidote, it is best to inject into the buttock (upper outer quadrant), anterolateral thigh, and outer shoulder. In an emergency, at the site of the lesion, the antidote is administered using a syringe tube and through clothing. After the injection, you need to attach an empty syringe tube to the victim’s clothing or put it in the right pocket, which will indicate that the antidote has been entered.
Sanitary treatment of the skin of the victim is carried out with a liquid from an individual anti-chemical package (IPP) directly at the site of the lesion, as this allows you to quickly stop exposure to toxic substances through unprotected skin. The PPI includes a flat bottle with a degasser, gauze swabs and a case (polyethylene bag).
When treating exposed skin with PPIs, follow these steps:
1. Open the package, take a swab from it and moisten it with the liquid from the package.
2. Wipe the exposed areas of the skin and the outer surface of the gas mask with a swab.
3. Re-moisten the swab and wipe the edges of the collar and the edges of the cuffs of the clothing that come into contact with the skin.
Please note that PPI liquid is poisonous and if it enters the eyes, it may be harmful to health.
If the agents are sprayed in an aerosol way, then the entire surface of the clothing will be contaminated. Therefore, after leaving the affected area, you should immediately take off your clothes, since the OM contained on it can cause damage due to evaporation into the breathing zone, penetration of vapors into the space under the suit.
In case of damage to the nerve agents of the nerve agent, the victim must be immediately evacuated from the source of infection to a safe area. During the evacuation of the affected, it is necessary to monitor their condition. To prevent seizures, repeated administration of the antidote is allowed.
If the affected person vomits, turn his head to the side and pull off the lower part of the gas mask, then put the gas mask back on. If necessary, the contaminated gas mask is replaced with a new one.
At negative ambient temperatures, it is important to protect the valve box of the gas mask from freezing. To do this, it is covered with a cloth and systematically warmed up.
In case of damage to asphyxiating agents (sarin, carbon monoxide, etc.), the victims are given artificial respiration.
4.6. First aid for a drowning person
A person cannot live without oxygen for more than 5 minutes, therefore, falling under water and being there for a long time, a person can drown. The causes of this situation can be different: cramps in the limbs when swimming in water bodies, exhaustion of strength during long swims, etc. Water, getting into the mouth and nose of the victim, fills the airways, and suffocation occurs. Therefore, assistance to a drowning person must be provided very quickly.
First aid to a drowning person begins with removing him to a hard surface. We especially note that the rescuer must be a good swimmer, otherwise both the drowning person and the rescuer may drown.
If the drowning man himself tries to stay on the surface of the water, he must be encouraged, a lifebuoy, a pole, an oar, the end of a rope should be thrown to him so that he can stay on the water until he is rescued.
The rescuer must be without shoes and clothes, in extreme cases without outerwear. You need to swim up to the drowning man carefully, preferably from behind, so that he does not grab the rescuer by the neck or by the arms and pull him to the bottom.
A drowning person is taken from behind under the armpits or by the back of the head near the ears and, holding the face above the water, they swim on their backs to the shore. You can grab a drowning person with one hand around the waist, only from behind.
Needed on the beach restore breathing the victim: quickly take off his clothes; free your mouth and nose from sand, dirt, silt; remove water from the lungs and stomach. Then the following steps are taken.
1. The first aid provider gets on one knee, puts the victim on the second knee with his stomach down.
2. The hand presses on the back between the shoulder blades of the victim until the foamy liquid stops flowing out of his mouth.
4. When the victim regains consciousness, he must be warmed by rubbing the body with a towel or overlaying it with heating pads.
5. To enhance cardiac activity, the victim is given a strong drink. hot tea or coffee.
6. Then the victim is transported to a medical facility.
If a drowning person has fallen through the ice, then it is impossible to run to help him on the ice when he is not strong enough, since the rescuer can also drown. You need to put a board or ladder on the ice and, carefully approaching, throw the end of the rope to the drowning person or stretch out a pole, oar, stick. Then, just as carefully, you need to help him get to the shore.
4.7. First aid for bites of poisonous insects, snakes and rabid animals
In the summer, a person can be stung by a bee, wasp, bumblebee, snake, and in some areas - a scorpion, tarantula or other poisonous insects. The wound from such bites is small and resembles a needle prick, but when bitten, poison penetrates through it, which, depending on its strength and quantity, either acts first on the area of \u200b\u200bthe body around the bite, or immediately causes general poisoning.
Single bites bees, wasps And bumblebees pose no particular danger. If a sting remains in the wound, it must be carefully removed, and a lotion of ammonia with water or a cold compress from a solution of potassium permanganate or simply cold water should be put on the wound.
bites poisonous snakes life-threatening. Usually snakes bite a person in the leg when he steps on them. Therefore, in places where snakes are found, you can not walk barefoot.
When bitten by a snake, the following symptoms are observed: burning pain at the site of the bite, redness, swelling. After half an hour, the leg can almost double in volume. At the same time, signs of general poisoning appear: loss of strength, muscle weakness, dizziness, nausea, vomiting, weak pulse, sometimes loss of consciousness.
bites poisonous insects very dangerous. Their venom causes not only severe pain and burning at the bite site, but sometimes general poisoning. The symptoms are reminiscent of poisoning by snake venom. In case of severe poisoning with the poison of a karakurt spider, death may occur in 1-2 days.
First aid for the bite of poisonous snakes and insects is as follows.
1. Above the bitten place, it is necessary to apply a tourniquet or twist to prevent the poison from entering the rest of the body.
2. The bitten limb must be lowered and try to squeeze out the blood from the wound, in which the poison is located.
You can not suck blood from the wound with your mouth, as there may be scratches or broken teeth in the mouth, through which the poison will penetrate into the blood of the one who provides assistance.
You can draw blood along with poison from the wound using medical jar, glasses or glasses with thick edges. To do this, in a jar (glass or glass), you need to hold a lit splinter or cotton wool on a stick for several seconds and then quickly cover the wound with it.
Each victim of a snake bite and poisonous insects must be transported to a medical facility.
From the bite rabid dog, cat, fox, wolf or other animal a person falls ill rabies. The bite site usually bleeds slightly. If an arm or leg is bitten, it must be quickly lowered and try to squeeze the blood out of the wound. When bleeding, the blood should not be stopped for some time. After that, the bite site is washed with boiled water, a clean bandage is applied to the wound and the patient is immediately sent to a medical facility, where the victim is given special vaccinations that will save him from a deadly disease - rabies.
It should also be remembered that rabies can be contracted not only from the bite of a rabid animal, but also in cases where its saliva gets on scratched skin or mucous membranes.
4.8. First aid for electric shock
Electric shocks are dangerous to human life and health. High voltage current can cause instant loss of consciousness and lead to death.
The voltage in the wires of residential premises is not so high, and if at home you carelessly grab a bare or poorly insulated electrical wire, pain and convulsive contraction of the muscles of the fingers are felt in the hand, and a small superficial burn of the upper skin can form. Such defeat does not bring great harm health and not dangerous to life if the house has grounding. If there is no grounding, then even a small current can lead to undesirable consequences.
A current of a stronger voltage causes convulsive contraction of the muscles of the heart, blood vessels, and respiratory organs. In such cases, there is a violation of blood circulation, a person may lose consciousness, while he turns pale sharply, his lips turn blue, breathing becomes barely noticeable, the pulse is palpable with difficulty. In severe cases, there may be no signs of life at all (breathing, heartbeat, pulse). There comes the so-called "imaginary death". In this case, a person can be brought back to life if he is immediately given first aid.
First aid in case of electric shock should begin with the termination of the current on the victim. If a broken bare wire falls on a person, it must be immediately discarded. This can be done with any object that conducts electricity poorly (a wooden stick, a glass or plastic bottle, etc.). If an accident occurs indoors, you must immediately turn off the switch, unscrew the plugs or simply cut the wires.
It should be remembered that the rescuer must take the necessary measures so that he himself does not suffer from the effects of electric current. To do this, when providing first aid, you need to wrap your hands with a non-conductive cloth (rubber, silk, woolen), put on dry rubber shoes on your feet or stand on a pack of newspapers, books, a dry board.
You can not take the victim by the naked parts of the body while the current continues to act on him. When removing the victim from the wire, you should protect yourself by wrapping your hands with an insulating cloth.
If the victim is unconscious, he must first be brought to his senses. To do this, you need to unbutton his clothes, sprinkle water on him, open windows or doors and give him artificial respiration - until spontaneous breathing appears and consciousness returns. Sometimes artificial respiration has to be done continuously for 2-3 hours.
Simultaneously with artificial respiration, the body of the victim must be rubbed and warmed with heating pads. When consciousness returns to the victim, he is put to bed, covered warmly and given a hot drink.
A patient who has been electrocuted may have various complications, so he must be sent to the hospital.
Another possible option for the impact of electric current on a person is lightning strike, the action of which is similar to the action of an electric current of very high voltage. In some cases, the affected person instantly dies from respiratory paralysis and cardiac arrest. Red streaks appear on the skin. However, being struck by lightning often comes down to nothing more than a severe stun. In such cases, the victim loses consciousness, his skin turns pale and cold, the pulse is barely palpable, breathing is shallow, barely noticeable.
Saving the life of a person struck by lightning depends on the speed of first aid. The victim should immediately start artificial respiration and continue it until he begins to breathe on his own.
To prevent the effects of lightning, a number of measures must be observed during rain and thunderstorms:
It is impossible during a thunderstorm to hide from the rain under a tree, as the trees "attract" a lightning bolt to themselves;
Elevated areas should be avoided during thunderstorms, as the probability of a lightning strike is higher in these places;
All residential and administrative premises must be equipped with lightning rods, the purpose of which is to prevent lightning from entering the building.
4.9. Complex of cardiopulmonary resuscitation. Its application and performance criteria
Cardiopulmonary resuscitation is a set of measures aimed at restoring cardiac activity and respiration of the victim when they stop (clinical death). This can happen when you hit electric shock, drowning, in some other cases when squeezing or blocking the airways. The probability of survival of the patient directly depends on the speed of resuscitation.
Most effective for artificial ventilation lungs are special devices with the help of which air is blown into the lungs. In the absence of such devices, artificial ventilation of the lungs is carried out in various ways, of which the most common is the mouth-to-mouth method.
The method of artificial ventilation of the lungs "mouth to mouth". To assist the victim, it is necessary to lay him on his back so that the airways are free for the passage of air. To do this, his head must be thrown back as much as possible. If the jaws of the victim are strongly compressed, it is necessary to push the lower jaw forward and, pressing on the chin, open the mouth, then clean the oral cavity from saliva or vomit with a napkin and proceed to artificial ventilation of the lungs:
1) put a napkin (handkerchief) in one layer on the open mouth of the victim;
2) pinch his nose;
3) take a deep breath;
4) tightly press your lips to the lips of the victim, creating tightness;
5) blow air into his mouth with force.
Air is blown rhythmically 16-18 times per minute until natural breathing is restored.
In case of injuries of the lower jaw, artificial ventilation of the lungs can be performed in a different way, when air is blown through the victim's nose. His mouth must be closed.
Artificial ventilation of the lungs is stopped when reliable signs of death.
Other methods of artificial lung ventilation. With extensive injuries of the maxillofacial region, it is impossible to artificially ventilate the lungs using the mouth-to-mouth or mouth-to-nose methods, therefore, the methods of Sylvester and Kallistov are used.
During artificial lung ventilation Sylvester's way the victim lies on his back, assisting him kneels at his head, takes both his hands by the forearms and sharply raises them, then takes them back behind him and spreads them apart - this is how a breath is made. Then, with a reverse movement, the victim's forearms are placed on the lower part of the chest and compress it - this is how exhalation occurs.
With artificial lung ventilation Kallistov's way the victim is laid on his stomach with arms extended forward, his head is turned to one side, putting clothes (blanket) under it. With stretcher straps or tied with two or three trouser belts, the victim is periodically (in the rhythm of breathing) raised to a height of up to 10 cm and lowered. When lifting the affected as a result of straightening his chest, inhalation occurs, when lowered due to its compression, exhalation occurs.
Signs of cardiac arrest and indirect massage hearts. Signs of cardiac arrest are:
Absence of pulse, palpitations;
Lack of pupillary response to light (dilated pupils).
Once these symptoms are identified, immediate action should be taken. indirect heart massage. For this:
1) the victim is laid on his back, on a hard, hard surface;
2) standing on the left side of him, put their palms one on top of the other on the region of the lower third of the sternum;
3) with energetic rhythmic pushes 50–60 times per minute, they press on the sternum, after each push, releasing their hands to allow the chest to expand. The anterior chest wall should be displaced to a depth of at least 3–4 cm.
An indirect heart massage is performed in combination with artificial ventilation of the lungs: 4-5 pressures on the chest (on exhalation) alternate with one blowing of air into the lungs (inhalation). In this case, the victim should be assisted by two or three people.
Artificial ventilation of the lungs in combination with chest compressions - the simplest way resuscitation(revival) of a person who is in a state of clinical death.
Signs of the effectiveness of the measures taken are the appearance of a person’s spontaneous breathing, the restored complexion, the appearance of a pulse and heartbeat, as well as a return to the sick consciousness.
After carrying out these activities, the patient must be provided with peace, he must be warmed, given a hot and sweet drink, and if necessary, apply tonics.
When carrying out artificial ventilation of the lungs and indirect heart massage, the elderly should remember that the bones at this age are more fragile, so the movements should be gentle. For small children, indirect massage is performed by pressing in the sternum area not with the palms, but with a finger.
4.10. Provision of medical assistance in case of natural disasters
natural disaster called an emergency situation in which human casualties and material losses are possible. Distinguish emergencies natural (hurricanes, earthquakes, floods, etc.) and anthropogenic (bomb explosions, accidents at enterprises) origin.
Sudden natural disasters and accidents require urgent medical assistance to the affected population. Of great importance are timely provision first aid directly at the site of injury (self-help and mutual assistance) and evacuation of victims from the outbreak to medical facilities.
The main type of injury in natural disasters is trauma, accompanied by life-threatening bleeding. Therefore, it is first necessary to take measures to stop bleeding, and then provide symptomatic medical care to the victims.
The content of measures to provide medical care to the population depends on the type of natural disaster, accident. Yes, at earthquakes this is the extraction of victims from the rubble, the provision of medical assistance to them, depending on the nature of the injury. At floods the first priority is to remove the victims from the water, warm them, stimulate cardiac and respiratory activity.
In the area affected tornado or hurricane, it is important to carry out triage affected, providing first aid to those most in need.
affected as a result snow drifts And collapses after being removed from under the snow, they warm them, then provide them with the necessary assistance.
In the outbreaks fires first of all, it is necessary to extinguish burning clothes on the victims, apply sterile dressings to the burned surface. If people are affected by carbon monoxide, immediately remove them from areas of intense smoke.
When accidents at nuclear power plants it is necessary to organize a radiation reconnaissance, which will make it possible to determine the levels of radioactive contamination of the territory. Radiation Control must be subjected to food, food raw materials, water.
Providing assistance to the victims. In the event of a lesion, the victims are provided with the following types of assistance:
First aid;
First medical aid;
Qualified and specialized medical care.
First aid is provided directly to the affected person at the site of injury by sanitary teams and sanitary posts, other units of the Russian Emergencies Ministry working in the outbreak, as well as in the order of self- and mutual assistance. Its main task is to save the life of the affected person and prevent possible complications. Removal of the injured to the places of loading onto transport is carried out by the porters of the rescue units.
The first medical aid to the injured is provided by medical units, medical units of military units and health care facilities that have been preserved in the outbreak. All these formations constitute the first stage of medical and evacuation support for the affected population. The tasks of first medical aid are to maintain the vital activity of the affected organism, prevent complications and prepare it for evacuation.
Qualified and specialized medical care for the injured is provided in medical institutions.
4.11. Medical care for radiation contamination
When providing first aid to victims of radiation contamination, it must be taken into account that in the contaminated area it is impossible to eat food, water from contaminated sources, or touch objects contaminated with radioactive substances. Therefore, first of all, it is necessary to determine the procedure for preparing food and purifying water in contaminated areas (or organizing delivery from uncontaminated sources), taking into account the level of contamination of the area and the current situation.
First medical aid to victims of radiation contamination should be provided in conditions of maximum reduction harmful effects. To do this, the victims are transported to an uninfected area or to special shelters.
Initially, it is necessary to take certain actions to save the life of the victim. First of all, it is necessary to organize sanitization and partial decontamination of his clothes and shoes to prevent harmful effects on the skin and mucous membranes. To do this, they wash with water and wipe the exposed skin of the victim with wet swabs, wash their eyes, and rinse their mouth. When decontaminating clothes and shoes, you must use personal protection to prevent the harmful effects of radioactive substances on the victim. It is also necessary to prevent contact of contaminated dust with other people.
If necessary, gastric lavage of the victim is carried out, absorbent agents are used ( Activated carbon and etc.).
Medical prophylaxis of radiation injuries is carried out with radioprotective agents available in an individual first-aid kit.
Individual first aid kit (AI-2) contains a set of medical supplies intended for personal prevention of injuries by radioactive, toxic substances and bacterial means. In case of radiation contamination, the following drugs contained in AI-2 are used:
- I nest - a syringe tube with an analgesic;
- III nest - antibacterial agent No. 2 (in an oblong pencil case), 15 tablets in total, which are taken after radiation exposure when gastrointestinal disorders: 7 tablets per reception on the first day and 4 tablets per reception daily for the next two days. The drug is taken to prevent infectious complications that may occur due to the weakening of the protective properties of the irradiated organism;
- IV nest - radioprotective agent No. 1 (pink cases with a white lid), 12 tablets in total. Take 6 tablets at the same time 30-60 minutes before the start of irradiation according to the civil defense alert signal in order to prevent radiation damage; then 6 tablets after 4-5 hours while in the territory contaminated with radioactive substances;
- VI slot - radioprotective agent No. 2 (white pencil case), 10 tablets in total. Take 1 tablet daily for 10 days when eating contaminated foods;
- VII nest - antiemetic (blue pencil case), 5 tablets in total. Use 1 tablet for contusions and primary radiation reaction to prevent vomiting. For children under the age of 8 years, take one fourth of the indicated dose, for children from 8 to 15 years old - half the dose.
Distribution medical preparations and instructions for their use are attached to an individual first-aid kit.
SUDDEN DEATH
Diagnostics. Lack of consciousness and pulse on the carotid arteries, a little later - the cessation of breathing.
In progress performing CPR- according to the ECP, ventricular fibrillation (in 80% of cases), asystole or electromechanical dissociation (in 10-20% of cases). If emergency ECG registration is not possible, they are guided by the manifestations of the onset of clinical death and the response to CPR.
Ventricular fibrillation develops suddenly, the symptoms appear sequentially: the disappearance of the pulse in the carotid arteries and loss of consciousness; a single tonic contraction of the skeletal muscles; violations and respiratory arrest. The response to timely CPR is positive, to the termination of CPR - fast negative.
With advanced SA- or AV-blockade, the symptoms develop relatively gradually: clouding of consciousness => motor excitation => moaning => tonic-clonic convulsions => respiratory disorders (MAS syndrome). When conducting a closed heart massage - a quick positive effect that persists for some time after the cessation of CPR.
Electromechanical dissociation in massive PE occurs suddenly (often at the time of physical exertion) and is manifested by the cessation of breathing, the absence of consciousness and pulse on the carotid arteries, and a sharp cyanosis of the skin of the upper half of the body. swelling of the neck veins. With the timely start of CPR, signs of its effectiveness are determined.
Electromechanical dissociation in myocardial rupture, cardiac tamponade develops suddenly (often after severe anginal syndrome), without convulsive syndrome, there are no signs of CPR effectiveness. Hypostatic spots quickly appear on the back.
Electromechanical dissociation due to other causes (hypovolemia, hypoxia, tension pneumothorax, drug overdose, progressive cardiac tamponade) does not occur suddenly, but develops against the background of the progression of the corresponding symptoms.
Urgent Care :
1. With ventricular fibrillation and the impossibility of immediate defibrillation:
Apply a precordial strike: Cover the xiphoid process with two fingers to protect it from damage. It is located at the bottom of the sternum, where the lower ribs converge, and can break off with a sharp blow and injure the liver. Inflict a pericardial blow with the edge of a palm clenched into a fist slightly above the xiphoid process covered with fingers. It looks like this: with two fingers of one hand you cover the xiphoid process, and with the fist of the other hand strike (while the elbow of the hand is directed along the body of the victim).
After that, check the pulse on the carotid artery. If the pulse does not appear, then your actions are not effective.
No effect - start CPR immediately, ensure that defibrillation is possible as soon as possible.
2. Closed heart massage should be performed at a frequency of 90 per 1 min with a compression-decompression ratio of 1:1: the method of active compression-decompression (using a cardiopamp) is more effective.
3. GOING in an accessible way (the ratio of massage movements and breathing is 5:1, and with the work of one doctor - 15:2), ensure the patency of the airways (tilt back the head, push the lower jaw, insert the air duct, sanitize the airways according to indications);
Use 100% oxygen:
Intubate the trachea (no more than 30 s);
Do not interrupt cardiac massage and ventilation for more than 30 s.
4. Catheterize a central or peripheral vein.
5. Adrenaline 1 mg every 3 minutes of CPR (how to administer here and below - see note).
6. As soon as possible - defibrillation 200 J;
No effect - defibrillation 300 J:
No effect - defibrillation 360 J:
No effect - see point 7.
7. Act according to the scheme: the drug - heart massage and mechanical ventilation, after 30-60 s - defibrillation 360 J:
Lidocaine 1.5 mg/kg - defibrillation 360 J:
No effect - after 3 minutes, repeat the injection of lidocaine at the same dose and defibrillation of 360 J:
No effect - Ornid 5 mg/kg - defibrillation 360 J;
No effect - after 5 minutes, repeat the injection of Ornid at a dose of 10 mg / kg - defibrillation 360 J;
No effect - novocainamide 1 g (up to 17 mg / kg) - defibrillation 360 J;
No effect - magnesium sulfate 2 g - defibrillation 360 J;
In pauses between discharges, conduct a closed heart massage and mechanical ventilation.
8. With asystole:
If it is impossible to accurately assess the electrical activity of the heart (do not exclude the atonic stage of ventricular fibrillation) - act. as in ventricular fibrillation (items 1-7);
If asystole is confirmed in two ECG leads, perform steps. 2-5;
No effect - atropine after 3-5 minutes, 1 mg until an effect is obtained or a total dose of 0.04 mg / kg is reached;
EKS as soon as possible;
Correct the possible cause of asystole (hypoxia, hypo- or hyperkalemia, acidosis, drug overdose, etc.);
The introduction of 240-480 mg of aminophylline can be effective.
9. With electromechanical dissociation:
Execute pp. 2-5;
Identify and correct its possible cause (massive PE - see relevant recommendations: cardiac tamponade - pericardiocentesis).
10. Monitor vital functions (heart monitor, pulse oximeter).
11. Hospitalize after possible stabilization of the condition.
12. CPR may be terminated if:
In the course of the procedure, it turned out that CPR is not indicated:
There is a persistent asystole that is not amenable to drug exposure, or multiple episodes of asystole:
When using all available methods no evidence of effective CPR within 30 min.
13. CPR may not be started:
In the terminal stage of an incurable disease (if the futility of CPR is documented in advance);
If more than 30 minutes have passed since the cessation of blood circulation;
With a previously documented refusal of the patient from CPR.
After defibrillation: asystole, ongoing or recurrent ventricular fibrillation, skin burn;
With mechanical ventilation: overflow of the stomach with air, regurgitation, aspiration of gastric contents;
With tracheal intubation: laryngo- and bronchospasm, regurgitation, damage to the mucous membranes, teeth, esophagus;
With closed heart massage: fracture of the sternum, ribs, lung damage, tension pneumothorax;
When puncturing the subclavian vein: bleeding, puncture subclavian artery, lymphatic duct, air embolism, tension pneumothorax:
With intracardiac injection: the introduction of drugs into the myocardium, damage to the coronary arteries, hemotamponade, lung injury, pneumothorax;
Respiratory and metabolic acidosis;
Hypoxic coma.
Note. In case of ventricular fibrillation and the possibility of immediate (within 30 s) defibrillation - defibrillation of 200 J, then proceed according to paragraphs. 6 and 7.
All drugs during CPR should be given rapidly intravenously.
When using a peripheral vein, mix the preparations with 20 ml of isotonic sodium chloride solution.
In the absence of venous access, adrenaline, atropine, lidocaine (increasing the recommended dose by 2 times) should be injected into the trachea in 10 ml of isotonic sodium chloride solution.
Intracardiac injections (with a thin needle, with strict observance of the technique of administration and control) are permissible in exceptional cases, with the absolute impossibility of using other routes of drug administration.
Sodium bicarbonate at 1 mmol / kg (4% solution - 2 ml / kg), then at 0.5 mmol / kg every 5-10 minutes, apply with very long CPR or with hyperkalemia, acidosis, an overdose of tricyclic antidepressants, hypoxic lactic acidosis that preceded the cessation of blood circulation ( exclusively under conditions of adequate ventilation1).
Calcium preparations are indicated only for severe initial hyperkalemia or an overdose of calcium antagonists.
In treatment-resistant ventricular fibrillation, reserve drugs are amiodarone and propranolol.
In case of asystole or electromechanical dissociation after tracheal intubation and administration of drugs, if the cause cannot be eliminated, decide on the termination of resuscitation measures, taking into account the time elapsed from the onset of circulatory arrest.
CARDIAC EMERGENCIES tachyarrhythmias
Diagnostics. Severe tachycardia, tachyarrhythmia.
Differential Diagnosis- ECG. It is necessary to distinguish between non-paroxysmal and paroxysmal tachycardias: tachycardias with a normal duration of the OK8 complex (supraventricular tachycardias, atrial fibrillation and flutter) and tachycardias with a wide 9K8 complex on the ECG (supraventricular tachycardias, atrial fibrillation, atrial flutter with transient or permanent blockade of the bundle pedicle P1ca: antidromic supraventricular pouch tachycardias ; atrial fibrillation in the syndrome of IgP\V; ventricular tachycardia).
Urgent Care
Emergency restoration of sinus rhythm or correction of heart rate is indicated for tachyarrhythmias complicated by acute circulatory disorders, with a threat of cessation of blood circulation, or with repeated paroxysms of tachyarrhythmias with a known method of suppression. In other cases, it is necessary to provide intensive monitoring and planned treatment (emergency hospitalization).
1. In case of cessation of blood circulation - CPR according to the recommendations of “Sudden Death”.
2. Shock or pulmonary edema (caused by tachyarrhythmia) are absolute vital indications for EIT:
Carry out oxygen therapy;
If the patient's condition allows, then premedicate (fentanyl 0.05 mg or promedol 10 mg intravenously);
Enter into drug sleep (diazepam 5 mg intravenously and 2 mg every 1-2 minutes before falling asleep);
Control your heart rate:
Perform EIT (with atrial flutter, supraventricular tachycardia, start with 50 J; with atrial fibrillation, monomorphic ventricular tachycardia - from 100 J; with polymorphic ventricular tachycardia - from 200 J):
If the patient's condition allows, synchronize the electrical impulse during EIT with the K wave on the ECL
Use well-moistened pads or gel;
At the moment of applying the discharge, press the electrodes against the chest wall with force:
Apply a discharge at the moment of exhalation of the patient;
Comply with safety regulations;
No effect - repeat EIT, doubling the discharge energy:
No effect - repeat EIT with a maximum energy discharge;
No effect - inject an antiarrhythmic drug indicated for this arrhythmia (see below) and repeat EIT with a maximum energy discharge.
3. With a clinically significant circulatory disorder ( arterial hypotension. anginal pain, increasing heart failure or neurological symptoms) or with repeated paroxysms of arrhythmia with a known method of suppression - to carry out emergency drug therapy. In the absence of effect, deterioration of the condition (and in the cases indicated below - and as an alternative to drug treatment) - EIT (p. 2).
3.1. With paroxysm of reciprocal supraventricular tachycardia:
Massage of the carotid sinus (or other vagal techniques);
No effect - inject ATP 10 mg intravenously with a push:
No effect - after 2 minutes ATP 20 mg intravenously with a push:
No effect - after 2 minutes verapamil 2.5-5 mg intravenously:
No effect - after 15 minutes verapamil 5-10 mg intravenously;
A combination of ATP or verapamil administration with vagal techniques may be effective:
No effect - after 20 minutes novocainamide 1000 mg (up to 17 mg / kg) intravenously at a rate of 50-100 mg / min (with a tendency to arterial hypotension - in one syringe with 0.25-0.5 ml of 1% mezaton solution or 0.1-0.2 ml of 0.2% norepinephrine solution).
3.2. With paroxysmal atrial fibrillation to restore sinus rhythm:
Novocainamide (clause 3.1);
With a high initial heart rate: first intravenously 0.25-0.5 mg of digoxin (strophanthin) and after 30 minutes - 1000 mg of novocainamide. To reduce heart rate:
Digoxin (strophanthin) 0.25-0.5 mg, or verapamil 10 mg intravenously slowly or 80 mg orally, or digoxin (strophanthin) intravenously and verapamil orally, or anaprilin 20-40 mg under the tongue or inside.
3.3. With paroxysmal atrial flutter:
If EIT is not possible, decrease in heart rate with the help of digoxin (strophanthin) and (or) verapamil (section 3.2);
To restore sinus rhythm, novo-cainamide after a preliminary injection of 0.5 mg of digoxin (strophanthin) may be effective.
3.4. With paroxysm of atrial fibrillation against the background of IPU syndrome:
Intravenous slow novocainamide 1000 mg (up to 17 mg/kg), or amiodarone 300 mg (up to 5 mg/kg). or rhythmylen 150 mg. or aimalin 50 mg: either EIT;
cardiac glycosides. blockers of p-adrenergic receptors, calcium antagonists (verapamil, diltazem) are contraindicated!
3.5. With paroxysm of antidromic reciprocal AV tachycardia:
Intravenously slowly novocainamide, or amiodarone, or aymalin, or rhythmylen (section 3.4).
3.6. In case of tactic arrhythmias against the background of SSSU to reduce heart rate:
Intravenously slowly 0.25 mg of digoxin (strophan tin).
3.7. With paroxysmal ventricular tachycardia:
Lidocaine 80-120 mg (1-1.5 mg/kg) and every 5 minutes at 40-60 mg (0.5-0.75 mg/kg) slowly intravenously until the effect or a total dose of 3 mg/kg is reached:
No effect - EIT (p. 2). or novocainamide. or amiodarone (section 3.4);
No effect - EIT or magnesium sulfate 2 g intravenously very slowly:
No effect - EIT or Ornid 5 mg/kg intravenously (for 5 minutes);
No effect - EIT or after 10 minutes Ornid 10 mg/kg intravenously (for 10 minutes).
3.8. With bidirectional spindle tachycardia.
EIT or intravenously slowly introduce 2 g of magnesium sulfate (if necessary, magnesium sulfate is administered again after 10 minutes).
3.9. In case of paroxysm of tachycardia of unknown origin with wide complexes 9K5 on the ECG (if there are no indications for EIT), administer intravenous lidocaine (section 3.7). no effect - ATP (p. 3.1) or EIT, no effect - novocainamide (p. 3.4) or EIT (p. 2).
4. In all cases of acute cardiac arrhythmia (except for repeated paroxysms with restored sinus rhythm), emergency hospitalization.
5. Continuously monitor heart rate and conduction.
Cessation of blood circulation (ventricular fibrillation, asystole);
MAC syndrome;
Acute heart failure (pulmonary edema, arrhythmic shock);
arterial hypotension;
Respiratory failure with the introduction of narcotic analgesics or diazepam;
Skin burns during EIT:
Thromboembolism after EIT.
Note. Emergency treatment of arrhythmias should be carried out only according to the indications given above.
If possible, the cause of the arrhythmia and its supporting factors should be addressed.
Emergency EIT with heart rate less than 150 in 1 min is usually not indicated.
With severe tachycardia and no indications for urgent restoration of sinus rhythm, it is advisable to reduce the heart rate.
If there are additional indications, before the introduction of antiarrhythmic drugs, potassium and magnesium preparations should be used.
With paroxysmal atrial fibrillation, the appointment of 200 mg of phencarol inside can be effective.
An accelerated (60-100 beats per minute) idioventricular or AV junctional rhythm is usually replacement, and antiarrhythmic drugs are not indicated in these cases.
To provide emergency care for repeated, habitual paroxysms of tachyarrhythmia should take into account the effectiveness of the treatment of previous paroxysms and factors that can change the patient's response to the introduction of antiarrhythmic drugs that helped him before.
BRADIARRHYTHMIAS
Diagnostics. Severe (heart rate less than 50 per minute) bradycardia.
Differential Diagnosis- ECG. Sinus bradycardia, SA node arrest, SA and AV block should be differentiated: AV block should be distinguished by degree and level (distal, proximal); in the presence of an implanted pacemaker, it is necessary to evaluate the effectiveness of stimulation at rest, with a change in body position and load.
Urgent Care . Intensive therapy is necessary if bradycardia (heart rate less than 50 beats per minute) causes MAC syndrome or its equivalents, shock, pulmonary edema, arterial hypotension, anginal pain, or there is a progressive decrease in heart rate or an increase in ectopic ventricular activity.
2. With MAS syndrome or bradycardia that caused acute heart failure, arterial hypotension, neurological symptoms, anginal pain, or with a progressive decrease in heart rate or an increase in ectopic ventricular activity:
Lay the patient with the lower limbs raised at an angle of 20 ° (if there is no pronounced stagnation in the lungs):
Carry out oxygen therapy;
If necessary (depending on the patient's condition) - closed heart massage or rhythmic tapping on the sternum ("fist rhythm");
Administer atropine 1 mg intravenously every 3-5 minutes until an effect is obtained or a total dose of 0.04 mg/kg is reached;
No effect - immediate endocardial percutaneous or transesophageal pacemaker:
There is no effect (or there is no possibility of conducting an EX-) - intravenous slow jet injection of 240-480 mg of aminophylline;
No effect - dopamine 100 mg or adrenaline 1 mg in 200 ml of 5% glucose solution intravenously; gradually increase the infusion rate until the minimum sufficient heart rate is reached.
3. Continuously monitor heart rate and conduction.
4. Hospitalize after possible stabilization of the condition.
The main dangers in complications:
asystole;
Ectopic ventricular activity (up to fibrillation), including after the use of adrenaline, dopamine. atropine;
Acute heart failure (pulmonary edema, shock);
Arterial hypotension:
Anginal pain;
Impossibility or inefficiency of EX-
Complications of endocardial pacemaker (ventricular fibrillation, perforation of the right ventricle);
Pain during transesophageal or percutaneous pacemaker.
UNSTABLE ANGINA
Diagnostics. The appearance of frequent or severe anginal attacks (or their equivalents) for the first time, a change in the course of pre-existing angina pectoris, the resumption or appearance of angina pectoris in the first 14 days of myocardial infarction, or the appearance of anginal pain for the first time at rest.
There are risk factors for the development or clinical manifestations of coronary artery disease. Changes on the ECG, even at the height of the attack, may be vague or absent!
Differential diagnosis. In most cases - with prolonged exertional angina, acute myocardial infarction, cardialgia. extracardiac pain.
Urgent Care
1. Shown:
Nitroglycerin (tablets or aerosol 0.4-0.5 mg under the tongue repeatedly);
oxygen therapy;
Correction of blood pressure and heart rate:
Propranolol (anaprilin, inderal) 20-40 mg orally.
2. With anginal pain (depending on its severity, age and condition of the patient);
Morphine up to 10 mg or neuroleptanalgesia: fentanyl 0.05-0.1 mg or promedol 10-20 mg with 2.5-5 mg droperidol intravenously fractionally:
With insufficient analgesia - intravenously 2.5 g of analgin, and with high blood pressure - 0.1 mg of clonidine.
5000 IU of heparin intravenously. and then drip 1000 IU / h.
5. Hospitalize after possible stabilization of the condition. Main dangers and complications:
Acute myocardial infarction;
Acute violations of the heart rhythm or conduction (up to sudden death);
Incomplete elimination or recurrence of anginal pain;
Arterial hypotension (including drug);
Acute heart failure:
Respiratory disorders with the introduction of narcotic analgesics.
Note. Emergency hospitalization is indicated, regardless of the presence of ECG changes, in blocks (wards) intensive care, departments for the treatment of patients with acute myocardial infarction.
It is necessary to ensure constant monitoring of heart rate and blood pressure.
For emergency care (in the first hours of the disease or in case of complications), catheterization of a peripheral vein is indicated.
In case of recurrent anginal pain or moist rales in the lungs, nitroglycerin should be administered intravenously by drip.
For the treatment of unstable angina, the rate of intravenous heparin administration must be selected individually, achieving a stable increase in activated partial thromboplastin time by 2 times compared to its normal value. It is much more convenient to use low molecular weight heparin enoxaparin (Clexane). 30 mg of Clexane is administered intravenously by stream, after which the drug is administered subcutaneously at 1 mg/kg 2 times a day for 3-6 days.
If traditional narcotic analgesics are absent, then you can assign 1-2 mg of butorphanol or 50-100 mg of tramadol with 5 mg of droperidol and (or) 2.5 g of analgin with 5 mg of diaepam intravenously slowly or fractionally.
MYOCARDIAL INFARCTION
Diagnostics. Characterized by chest pain (or its equivalents) with irradiation to the left (sometimes to the right) shoulder, forearm, shoulder blade, neck. lower jaw, epigastric region; heart rhythm and conduction disturbances, blood pressure instability: the reaction to nitroglycerin is incomplete or absent. Other variants of the onset of the disease are less commonly observed: asthmatic (cardiac asthma, pulmonary edema). arrhythmic (fainting, sudden death, MAC syndrome). cerebrovascular (acute neurological symptoms), abdominal (pain in the epigastric region, nausea, vomiting), asymptomatic (weakness, vague sensations in the chest). In the anamnesis - risk factors or signs of coronary artery disease, the appearance for the first time or a change in habitual anginal pain. ECG changes (especially in the first hours) may be vague or absent! After 3-10 hours from the onset of the disease - a positive test with troponin-T or I.
Differential diagnosis. In most cases - with prolonged angina pectoris, unstable angina, cardialgia. extracardiac pain. PE, acute diseases of the abdominal organs (pancreatitis, cholecystitis, etc.), dissecting aortic aneurysm.
Urgent Care
1. Shown:
Physical and emotional peace:
Nitroglycerin (tablets or aerosol 0.4-0.5 mg under the tongue repeatedly);
oxygen therapy;
Correction of blood pressure and heart rate;
Acetylsalicylic acid 0.25 g (chew);
Propranolol 20-40 mg orally.
2. For pain relief (depending on the severity of pain, the age of the patient, his condition):
Morphine up to 10 mg or neuroleptanalgesia: fentanyl 0.05-0.1 mg or promedol 10-20 mg with 2.5-5 mg droperidol intravenously fractionally;
With insufficient analgesia - intravenously 2.5 g of analgin, and against the background of high blood pressure - 0.1 mg of clonidine.
3. To restore coronary blood flow:
In case of transmural myocardial infarction with a rise in the 8T segment on the ECG (in the first 6, and with recurrent pain - up to 12 hours from the onset of the disease), inject streptokinase 1,500,000 IU intravenously in 30 minutes as early as possible:
In case of subendocardial myocardial infarction with depression of the 8T segment on the ECG (or the impossibility of thrombolytic therapy), 5000 units of heparin are administered intravenously as soon as possible, and then drip.
4. Continuously monitor heart rate and conduction.
5. Hospitalize after possible stabilization of the condition.
Main dangers and complications:
Acute cardiac arrhythmias and conduction disorders up to sudden death (ventricular fibrillation), especially in the first hours of myocardial infarction;
Recurrence of anginal pain;
Arterial hypotension (including medication);
Acute heart failure (cardiac asthma, pulmonary edema, shock);
arterial hypotension; allergic, arrhythmic, hemorrhagic complications with the introduction of streptokinase;
Respiratory disorders with the introduction of narcotic analgesics;
Myocardial rupture, cardiac tamponade.
Note. For emergency care (in the first hours of the disease or with the development of complications), catheterization of a peripheral vein is indicated.
With recurrent anginal pain or moist rales in the lungs, nitroglycerin should be administered intravenously by drip.
With an increased risk of developing allergic complications, 30 mg of prednisolone should be administered intravenously before the appointment of streptokinase. When conducting thrombolytic therapy, ensure control over the heart rate and basic hemodynamic parameters, readiness to correct possible complications (presence of a defibrillator, a ventilator).
For the treatment of subendocardial (with 8T segment depression and without pathological O wave) myocardial infarction, the rate of intravenous administration of gegyurin must be selected individually, achieving a stable increase in activated partial thromboplastin time by 2 times compared to its normal value. It is much more convenient to use low molecular weight heparin enoxaparin (Clexane). 30 mg of Clexane is administered intravenously by stream, after which the drug is administered subcutaneously at 1 mg/kg 2 times a day for 3-6 days.
If traditional narcotic analgesics are not available, then 1-2 mg of butorphanol or 50-100 mg of tramadol with 5 mg of droperidol and (or) 2.5 g of analgin with 5 mg of diaepam can be prescribed intravenously slowly or fractionally.
CARDIOGENIC PULMONARY EDEMA
Diagnostics. Characteristic: suffocation, shortness of breath, aggravated in the prone position, which forces patients to sit down: tachycardia, acrocyanosis. tissue hyperhydration, inspiratory dyspnea, dry wheezing, then moist rales in the lungs, abundant foamy sputum, ECG changes (hypertrophy or overload of the left atrium and ventricle, blockade of the left leg of the Pua bundle, etc.).
History of myocardial infarction, malformation or other heart disease. hypertension, chronic heart failure.
Differential diagnosis. In most cases, cardiogenic pulmonary edema is differentiated from non-cardiogenic (with pneumonia, pancreatitis, cerebral circulation, chemical damage to the lungs, etc.), pulmonary embolism, bronchial asthma.
Urgent Care
1. General activities:
oxygen therapy;
Heparin 5000 IU intravenous bolus:
Correction of heart rate (with a heart rate of more than 150 in 1 min - EIT. with a heart rate of less than 50 in 1 min - EX);
With abundant foam formation - defoaming (inhalation of a 33% solution ethyl alcohol or intravenously 5 ml of 96% ethanol solution and 15 ml of 40% glucose solution), in extremely severe (1) cases, 2 ml of 96% ethanol solution is injected into the trachea.
2. With normal blood pressure:
Run step 1;
To seat the patient with lowered lower limbs;
Nitroglycerin tablets (preferably aerosol) 0.4-0.5 mg sublingually again after 3 minutes or up to 10 mg intravenously slowly fractionally or intravenously drip in 100 ml of isotonic sodium chloride solution, increasing the rate of administration from 25 μg / min until effect by controlling blood pressure:
Diazepam up to 10 mg or morphine 3 mg intravenously in divided doses until the effect or a total dose of 10 mg is reached.
3. With arterial hypertension:
Run step 1;
Seating a patient with lowered lower limbs:
Nitroglycerin, tablets (aerosol is better) 0.4-0.5 mg under the tongue once;
Furosemide (Lasix) 40-80 mg IV;
Nitroglycerin intravenously (item 2) or sodium nitroprusside 30 mg in 300 ml of 5% glucose solution intravenously drip, gradually increasing the infusion rate of the drug from 0.3 μg / (kg x min) until the effect is obtained, controlling blood pressure, or pentamine to 50 mg intravenously fractionally or drip:
Intravenously up to 10 mg of diazepam or up to 10 mg of morphine (item 2).
4. With severe arterial hypotension:
Run step 1:
Lay down the patient, raising the head;
Dopamine 200 mg in 400 ml of 5% glucose solution intravenously, increasing the infusion rate from 5 μg / (kg x min) until blood pressure stabilizes at the minimum sufficient level;
If it is impossible to stabilize blood pressure, additionally prescribe norepinephrine hydrotartrate 4 mg in 200 ml of 5-10% glucose solution, increasing the infusion rate from 0.5 mcg / min until blood pressure stabilizes at the minimum sufficient level;
With an increase in blood pressure, accompanied by increasing pulmonary edema, additionally nitroglycerin intravenously drip (p. 2);
Furosemide (Lasix) 40 mg IV after stabilization of blood pressure.
5. Monitor vital functions (cardiomonitor, pulse oximeter).
6. Hospitalize after possible stabilization of the condition. Main dangers and complications:
Lightning form of pulmonary edema;
Airway obstruction with foam;
respiratory depression;
tachyarrhythmia;
asystole;
Anginal pain:
The increase in pulmonary edema with an increase in blood pressure.
Note. Under the minimum sufficient blood pressure should be understood as a systolic pressure of about 90 mm Hg. Art. provided that the increase in blood pressure is accompanied by clinical signs of improved perfusion of organs and tissues.
Eufillin in cardiogenic pulmonary edema is an adjuvant and can be indicated for bronchospasm or severe bradycardia.
Glucocorticoid hormones are used only for respiratory distress syndrome (aspiration, infection, pancreatitis, inhalation of irritants, etc.).
Cardiac glycosides (strophanthin, digoxin) can be prescribed only for moderate congestive heart failure in patients with tachysystolic atrial fibrillation (flutter).
At aortic stenosis, hypertrophic cardiomyopathy, cardiac tamponade, nitroglycerin and other peripheral vaedilators are relatively contraindicated.
It is effective to create positive end-expiratory pressure.
For the prevention of recurrence of pulmonary edema in patients with chronic heart failure are useful ACE inhibitors(captopril). At the first appointment of captopril, treatment should begin with a trial dose of 6.25 mg.
CARDIOGENIC SHOCK
Diagnostics. A pronounced decrease in blood pressure in combination with signs of impaired blood supply to organs and tissues. Systolic blood pressure is usually below 90 mm Hg. Art., pulse - below 20 mm Hg. Art. There are symptoms of deterioration of the peripheral circulation (pale cyanotic moist skin, collapsed peripheral veins, a decrease in the temperature of the skin of the hands and feet); decrease in blood flow velocity (the time for the disappearance of a white spot after pressing on the nail bed or palm is more than 2 s), a decrease in diuresis (less than 20 ml / h), impaired consciousness (from mild inhibition to the appearance of focal neurological symptoms and the development of coma).
Differential diagnosis. In most cases, it is necessary to differentiate true cardiogenic shock from its other varieties (reflex, arrhythmic, drug-induced, with slow myocardial rupture, rupture of the septum or papillary muscles, right ventricular damage), as well as from pulmonary embolism, hypovolemia, internal bleeding and arterial hypotension without shock.
Urgent Care
Emergency care must be carried out in stages, quickly moving on to the next stage if the previous one is ineffective.
1. In the absence of pronounced stagnation in the lungs:
Lay the patient down with the lower limbs raised at an angle of 20° (with severe congestion in the lungs - see “Pulmonary edema”):
Carry out oxygen therapy;
With anginal pain, conduct a full anesthesia:
Perform heart rate correction (paroxysmal tachyarrhythmia with a heart rate of more than 150 beats per 1 min - absolute reading to EIT, acute bradycardia with heart rate less than 50 beats per 1 min - to EKS);
Administer heparin 5000 IU intravenously by bolus.
2. In the absence of pronounced stagnation in the lungs and signs of a sharp increase in CVP:
Introduce 200 ml of 0.9% sodium chloride solution intravenously over 10 minutes under the control of blood pressure and respiratory rate. Heart rate, auscultatory picture of the lungs and heart (if possible, control CVP or wedge pressure in pulmonary artery);
If arterial hypotension persists and there are no signs of transfusion hypervolemia, repeat the introduction of fluid according to the same criteria;
In the absence of signs of transfusion hypervolemia (CVD below 15 cm of water column), continue infusion therapy at a rate of up to 500 ml / h, monitoring these indicators every 15 minutes.
If blood pressure cannot be quickly stabilized, then proceed to the next step.
3. Inject dopamine 200 mg in 400 ml of 5% glucose solution intravenously, increasing the infusion rate starting from 5 µg/(kg x min) until the minimum sufficient arterial pressure is reached;
No effect - additionally prescribe norepinephrine hydrotartrate 4 mg in 200 ml of 5% glucose solution intravenously, increasing the infusion rate from 0.5 μg / min until the minimum sufficient arterial pressure is reached.
4. Monitor vital functions: heart monitor, pulse oximeter.
5. Hospitalize after possible stabilization of the condition.
Main dangers and complications:
Late diagnosis and initiation of treatment:
Failure to stabilize blood pressure:
Pulmonary edema with increased blood pressure or intravenous fluids;
Tachycardia, tachyarrhythmia, ventricular fibrillation;
Asystole:
Recurrence of anginal pain:
Acute renal failure.
Note. Under the minimum sufficient blood pressure should be understood as a systolic pressure of about 90 mm Hg. Art. when signs of improvement in perfusion of organs and tissues appear.
Glucocorpoid hormones are not indicated in true cardiogenic shock.
emergency angina heart attack poisoning
HYPERTENSIVE CRISES
Diagnostics. Increased blood pressure (usually acute and significant) with neurological symptoms: headache, “flies” or a veil before the eyes, paresthesia, a feeling of “crawling”, nausea, vomiting, weakness in the limbs, transient hemiparesis, aphasia, diplopia.
With a neurovegetative crisis (type I crisis, adrenal): sudden onset. excitation, hyperemia and moisture of the skin. tachycardia, frequent and copious urination, a predominant increase in systolic pressure with an increase in pulse.
With a water-salt form of a crisis (crisis type II, noradrenal): gradual onset, drowsiness, adynamia, disorientation, pallor and puffiness of the face, swelling, a predominant increase in diastolic pressure with a decrease in pulse pressure.
With a convulsive form of a crisis: a throbbing, arching headache, psychomotor agitation, repeated vomiting without relief, visual disturbances, loss of consciousness, clonic-tonic convulsions.
Differential diagnosis. First of all, one should take into account the severity, form and complications of the crisis, highlight the crises associated with the sudden cancellation antihypertensive drugs(clonidine, p-blockers, etc.), to differentiate hypertensive crises from cerebrovascular accident, diencephalic crises and crises in pheochromocytoma.
Urgent Care
1. Neurovegetative form of crisis.
1.1. For mild flow:
Nifedipine 10 mg sublingually or in drops orally every 30 minutes, or clonidine 0.15 mg sublingually. then 0.075 mg every 30 minutes until the effect, or a combination of these drugs.
1.2. With severe flow.
Clonidine 0.1 mg intravenously slowly (can be combined with 10 mg of nifedipine under the tongue), or sodium nitroprusside 30 mg in 300 ml of 5% glucose solution intravenously, gradually increasing the rate of administration until the required blood pressure is reached, or pentamine up to 50 mg intravenously drip or jet fractionally;
With insufficient effect - furosemide 40 mg intravenously.
1.3. With continued emotional tension, additional diazepam 5-10 mg orally, intramuscularly or intravenously, or droperidol 2.5-5 mg intravenously slowly.
1.4. With persistent tachycardia, propranolol 20-40 mg orally.
2. Water-salt form of crisis.
2.1. For mild flow:
Furosemide 40–80 mg orally once and nifedipine 10 mg sublingually or in drops orally every 30 minutes until effect, or furosemide 20 mg orally once and captopril 25 mg sublingually or orally every 30–60 minutes until effect.
2.2. With severe flow.
Furosemide 20-40 mg intravenously;
Sodium nitroprusside or pentamine intravenously (section 1.2).
2.3. With persistent neurological symptoms, it can be effective intravenous administration 240 mg aminophylline.
3. Convulsive form of crisis:
Diazepam 10-20 mg intravenously slowly until seizures are eliminated, magnesium sulfate 2.5 g intravenously very slowly can be administered additionally:
Sodium nitroprusside (section 1.2) or pentamine (section 1.2);
Furosemide 40-80 mg intravenously slowly.
4. Crises associated with the sudden withdrawal of antihypertensive drugs:
Appropriate antihypertensive drug intravenously. under the tongue or inside, with pronounced arterial hypertension - sodium nitroprusside (section 1.2).
5. Hypertensive crisis complicated by pulmonary edema:
Nitroglycerin (preferably an aerosol) 0.4-0.5 mg under the tongue and immediately 10 mg in 100 ml of isotonic sodium chloride solution intravenously. by increasing the rate of infusion from 25 µg/min until effect is obtained, either sodium nitroprusside (section 1.2) or pentamine (section 1.2);
Furosemide 40-80 mg intravenously slowly;
Oxygen therapy.
6. Hypertensive crisis complicated by hemorrhagic stroke or subarachnoid hemorrhage:
With pronounced arterial hypertension - sodium nitroprusside (section 1.2). reduce blood pressure to values exceeding the usual values for this patient, with an increase in neurological symptoms, reduce the rate of administration.
7. Hypertensive crisis complicated by anginal pain:
Nitroglycerin (preferably an aerosol) 0.4-0.5 mg under the tongue and immediately 10 mg intravenously drip (item 5);
Required anesthesia - see "Angina":
With insufficient effect - propranolol 20-40 mg orally.
8. With a complicated course- monitor vital functions (heart monitor, pulse oximeter).
9. Hospitalize after possible stabilization of the condition .
Main dangers and complications:
arterial hypotension;
Violation of cerebral circulation (hemorrhagic or ischemic stroke);
Pulmonary edema;
Anginal pain, myocardial infarction;
Tachycardia.
Note. In acute arterial hypertension, immediately shortening life, reduce blood pressure within 20-30 minutes to the usual, “working” or slightly higher values, use intravenous. the route of administration of drugs, the hypotensive effect of which can be controlled (sodium nitroprusside, nitroglycerin.).
In a hypertensive crisis without an immediate threat to life, lower blood pressure gradually (for 1-2 hours).
When the course of hypertension worsens, not reaching a crisis, blood pressure must be reduced within a few hours, the main antihypertensive drugs should be administered orally.
In all cases, blood pressure should be reduced to the usual, "working" values.
To provide emergency care for repeated hypertensive crises of SLS diets, taking into account the existing experience in the treatment of previous ones.
When using captopril for the first time, treatment should begin with a trial dose of 6.25 mg.
The hypotensive effect of pentamine is difficult to control, so the drug can only be used in cases where an emergency lowering of blood pressure is indicated and there are no other options for this. Pentamine is administered in doses of 12.5 mg intravenously in fractions or drops up to 50 mg.
In a crisis in patients with pheochromocytoma, raise the head of the bed to. 45°; prescribe (rentolation (5 mg intravenously 5 minutes before the effect.); you can use prazosin 1 mg sublingually repeatedly or sodium nitroprusside. As an auxiliary drug, droperidol 2.5-5 mg intravenously slowly. Blockers of P-adrenoreceptors should be changed only (!) after the introduction of a-adrenergic blockers.
PULMONARY EMBOLISM
Diagnostics Massive pulmonary embolism is manifested by sudden circulatory arrest (electromechanical dissociation), or shock with severe shortness of breath, tachycardia, pallor or sharp cyanosis of the skin of the upper half of the body, swelling of the jugular veins, antinose-like pain, electrocardiographic manifestations of acute cor pulmonale.
Non-gossive PE is manifested by shortness of breath, tachycardia, arterial hypotension. signs of pulmonary infarction (pulmonary-pleural pain, cough, in some patients - with sputum stained with blood, fever, crepitant wheezing in the lungs).
For the diagnosis of PE, it is important to take into account the presence of risk factors for the development of thromboembolism, such as a history of thromboembolic complications, advanced age, prolonged immobilization, recent surgery, heart disease, heart failure, atrial fibrillation, oncological diseases, DVT.
Differential diagnosis. In most cases - with myocardial infarction, acute heart failure (cardiac asthma, pulmonary edema, cardiogenic shock), bronchial asthma, pneumonia, spontaneous pneumothorax.
Urgent Care
1. With the cessation of blood circulation - CPR.
2. With massive PE with arterial hypotension:
Oxygen therapy:
Catheterization of the central or peripheral vein:
Heparin 10,000 IU intravenously by stream, then drip at an initial rate of 1000 IU / h:
Infusion therapy (reopoliglyukin, 5% glucose solution, hemodez, etc.).
3. In case of severe arterial hypotension, not corrected by infusion therapy:
Dopamine, or adrenaline intravenously drip. increasing the rate of administration until blood pressure stabilizes;
Streptokinase (250,000 IU intravenously drip for 30 minutes, then intravenously drip at a rate of 100,000 IU/h to a total dose of 1,500,000 IU).
4. With stable blood pressure:
oxygen therapy;
Catheterization of a peripheral vein;
Heparin 10,000 IU intravenously by stream, then drip at a rate of 1000 IU / h or subcutaneously at 5000 IU after 8 hours:
Eufillin 240 mg intravenously.
5. In case of recurrent PE, additionally prescribe 0.25 g of acetylsalicylic acid orally.
6. Monitor vital functions (heart monitor, pulse oximeter).
7. Hospitalize after possible stabilization of the condition.
Main dangers and complications:
Electromechanical dissociation:
Inability to stabilize blood pressure;
Increasing respiratory failure:
PE recurrence.
Note. With a aggravated allergic history, 30 mg of predniolone is administered intravenously by stream before the appointment of strepyayukinoz.
For the treatment of PE, the rate of intravenous heparin administration must be selected individually, achieving a stable increase in activated partial thromboplastin time by 2 times compared to its normal value.
STROKE (ACUTE CEREBRAL CIRCULATION DISTURBANCE)
Stroke (stroke) is a rapidly developing focal or global impairment of brain function, lasting more than 24 hours or leading to death if another genesis of the disease is excluded. It develops against the background of atherosclerosis of cerebral vessels, hypertension, their combination or as a result of rupture of cerebral aneurysms.
Diagnostics The clinical picture depends on the nature of the process (ischemia or hemorrhage), localization (hemispheres, trunk, cerebellum), the rate of development of the process (sudden, gradual). A stroke of any genesis is characterized by the presence of focal symptoms of brain damage (hemiparesis or hemiplegia, less often monoparesis and damage to the cranial nerves - facial, hypoglossal, oculomotor) and cerebral symptoms varying degrees of severity (headache, dizziness, nausea, vomiting, impaired consciousness).
CVA is clinically manifested by subarachnoid or intracerebral hemorrhage (hemorrhagic stroke), or ischemic stroke.
Transient cerebrovascular accident (TIMC) is a condition in which focal symptoms undergo complete regression over a period of less than 24 hours. The diagnosis is made retrospectively.
Suborocnoid hemorrhages develop as a result of rupture of aneurysms and less often against the background of hypertension. Characterized by the sudden onset of a sharp headache, followed by nausea, vomiting, motor agitation, tachycardia, sweating. With massive subarachnoid hemorrhage, as a rule, depression of consciousness is observed. Focal symptoms are often absent.
Hemorrhagic stroke - bleeding into the substance of the brain; characterized by a sharp headache, vomiting, rapid (or sudden) depression of consciousness, accompanied by the appearance of pronounced symptoms of dysfunction of the limbs or bulbar disorders (peripheral paralysis of the muscles of the tongue, lips, soft palate, pharynx, vocal folds and epiglottis due to damage to the IX, X and XII pairs of cranial nerves or their nuclei located in the medulla oblongata). It usually develops during the day, during wakefulness.
Ischemic stroke is a disease that leads to a decrease or cessation of blood supply to a certain part of the brain. It is characterized by a gradual (over hours or minutes) increase in focal symptoms corresponding to the affected vascular pool. Cerebral symptoms are usually less pronounced. Develops more often with normal or low blood pressure, often during sleep
At the prehospital stage, it is not required to differentiate the nature of the stroke (ischemic or hemorrhagic, subarachnoid hemorrhage and its localization.
Differential diagnosis should be carried out with a traumatic brain injury (history, the presence of traces of trauma on the head) and much less often with meningoencephalitis (history, signs of a general infectious process, rash).
Urgent Care
Basic (undifferentiated) therapy includes emergency correction of vital important functions- restoration of patency of the upper respiratory tract, if necessary - tracheal intubation, artificial ventilation of the lungs, as well as normalization of hemodynamics and cardiac activity:
With arterial pressure significantly higher than usual values - its decrease to indicators slightly higher than the “working” one, which is familiar to this patient, if there is no information, then to the level of 180/90 mm Hg. Art.; for this use - 0.5-1 ml of a 0.01% solution of clonidine (clophelin) in 10 ml of a 0.9% solution of sodium chloride intravenously or intramuscularly or 1-2 tablets sublingually (if necessary, the administration of the drug can be repeated), or pentamine - no more than 0, 5 ml of a 5% solution intravenously at the same dilution or 0.5-1 ml intramuscularly:
As additional funds you can use dibazole 5-8 ml of a 1% solution intravenously or nifedipine (corinfar, fenigidin) - 1 tablet (10 mg) sublingually;
For the relief of convulsive seizures, psychomotor agitation - diazepam (Relanium, Seduxen, Sibazon) 2-4 ml intravenously with 10 ml of 0.9% sodium chloride solution slowly or intramuscularly or Rohypnol 1-2 ml intramuscularly;
With inefficiency - 20% solution of sodium hydroxybutyrate at the rate of 70 mg / kg of body weight in 5-10% glucose solution intravenously slowly;
In case of repeated vomiting - cerucal (raglan) 2 ml intravenously in a 0.9% solution intravenously or intramuscularly:
Vitamin Wb 2 ml of 5% solution intravenously;
Droperidol 1-3 ml of 0.025% solution, taking into account the patient's body weight;
With a headache - 2 ml of a 50% solution of analgin or 5 ml of baralgin intravenously or intramuscularly;
Tramal - 2 ml.
Tactics
For patients of working age in the first hours of the disease, it is mandatory to call a specialized neurological (neuroresuscitation) team. Shown hospitalization on a stretcher in the neurological (neurovascular) department.
In case of refusal of hospitalization - a call to the neurologist of the polyclinic and, if necessary, an active visit to the emergency doctor after 3-4 hours.
Non-transportable patients in deep atonic coma (5-4 points on the Glasgow scale) with intractable severe respiratory disorders: unstable hemodynamics, with a rapid, steady deterioration.
Dangers and Complications
Obstruction of the upper respiratory tract by vomit;
Aspiration of vomit;
Inability to normalize blood pressure:
swelling of the brain;
Breakthrough of blood into the ventricles of the brain.
Note
1. Early use of antihypoxants and activators of cellular metabolism is possible (nootropil 60 ml (12 g) intravenously bolus 2 times a day after 12 hours on the first day; cerebrolysin 15-50 ml intravenously by drip per 100-300 ml of isotonic solution in 2 doses; glycine 1 tablet under the tongue riboyusin 10 ml intravenously bolus, solcoseryl 4 ml intravenous bolus, in severe cases 250 ml 10% solution of solcoseryl intravenously drip can significantly reduce the number of irreversibly damaged cells in the ischemic zone, reduce the area of perifocal edema.
2. Aminazine and propazine should be excluded from the funds prescribed for any form of stroke. These drugs sharply inhibit the functions of the brain stem structures and clearly worsen the condition of patients, especially the elderly and senile.
3. Magnesium sulfate is not used when convulsive syndrome and to lower blood pressure.
4. Eufillin is shown only in the first hours of an easy stroke.
5. Furosemide (Lasix) and other dehydrating agents (mannitol, reogluman, glycerol) should not be administered in the prehospital setting. The need to prescribe dehydrating agents can only be determined in a hospital based on the results of determining plasma osmolality and sodium content in blood serum.
6. In the absence of a specialized neurological team, hospitalization in the neurological department is indicated.
7. For patients of any age with the first or repeated stroke with minor defects after previous episodes, a specialized neurological (neuroresuscitation) team can also be called on the first day of the disease.
BRONCHOASTMATIC STATUS
Bronchoasthmatic status is one of the most severe variants of the course of bronchial asthma, manifested by acute obstruction. bronchial tree as a result of bronchiolospasm, hyperergic inflammation and edema of the mucous membrane, hypersecretion of the glandular apparatus. The formation of the status is based on a deep blockade of p-adrenergic receptors of the smooth muscles of the bronchi.
Diagnostics
An attack of suffocation with difficulty exhaling, increasing dyspnea at rest, acrocyanosis, increased sweating, hard breathing with dry scattered wheezing and the subsequent formation of areas of a “silent” lung, tachycardia, high blood pressure, participation in breathing of auxiliary muscles, hypoxic and hypercapnic coma. When conducting drug therapy, resistance to sympathomimetics and other bronchodilators is revealed.
Urgent Care
Asthmatic status is a contraindication to the use of β-agonists (agonists) due to loss of sensitivity (lung receptors to these drugs. However, this loss of sensitivity can be overcome with the help of nebulizer technique.
Drug therapy is based on the use of selective p2-agonists fenoterol (berotec) at a dose of 0.5-1.5 mg or salbutamol at a dose of 2.5-5.0 mg or a complex preparation of berodual containing fenoterol and the anticholinergic drug ypra using nebulizer technology. -tropium bromide (atrovent). The dosage of berodual is 1-4 ml per inhalation.
In the absence of a nebulizer, these drugs are not used.
Eufillin is used in the absence of a nebulizer or in especially severe cases with the ineffectiveness of nebulizer therapy.
The initial dose is 5.6 mg / kg of body weight (10-15 ml of a 2.4% solution intravenously slowly, over 5-7 minutes);
Maintenance dose - 2-3.5 ml of a 2.4% solution fractionally or drip until the patient's clinical condition improves.
Glucocorticoid hormones - in terms of methylprednisolone 120-180 mg intravenously by stream.
Oxygen therapy. Continuous insufflation (mask, nasal catheters) of an oxygen-air mixture with an oxygen content of 40-50%.
Heparin - 5,000-10,000 IU intravenously with one of the plasma-substituting solutions; it is possible to use low molecular weight heparins (fraxiparin, clexane, etc.)
Contraindicated
Sedatives and antihistamines (inhibit the cough reflex, increase bronchopulmonary obstruction);
Mucolytic mucus thinners:
antibiotics, sulfonamides, novocaine (have a high sensitizing activity);
Calcium preparations (deepen initial hypokalemia);
Diuretics (increase initial dehydration and hemoconcentration).
In a coma
Urgent tracheal intubation for spontaneous breathing:
Artificial ventilation of the lungs;
If necessary - cardiopulmonary resuscitation;
Medical therapy (see above)
Indications for tracheal intubation and mechanical ventilation:
hypoxic and hyperkalemic coma:
Cardiovascular collapse:
The number of respiratory movements is more than 50 in 1 min. Transportation to the hospital against the background of ongoing therapy.
SEVERAL SYNDROME
Diagnostics
A generalized generalized convulsive seizure is characterized by the presence of tonic-clonic convulsions in the limbs, accompanied by loss of consciousness, foam at the mouth, often - biting of the tongue, involuntary urination, sometimes defecation. At the end of the seizure, there is a pronounced respiratory arrhythmia. Possible long periods apnea. At the end of the seizure, the patient is in a deep coma, the pupils are maximally dilated, without reaction to light, the skin is cyanotic, often moist.
Simple partial seizures without loss of consciousness are manifested by clonic or tonic convulsions in certain muscle groups.
Complex partial seizures ( temporal lobe epilepsy or psychomotor seizures) - episodic changes in behavior when the patient loses contact with the outside world. The beginning of such seizures may be the aura (olfactory, gustatory, visual, sensation of “already seen”, micro or macropsia). During complex attacks, inhibition of motor activity may be observed; or smacking tubas, swallowing, walking aimlessly, picking off one's own clothes (automatisms). At the end of the attack, amnesia is noted for the events that took place during the attack.
The equivalents of convulsive seizures are manifested in the form of gross disorientation, somnambulism and a prolonged twilight state, during which unconscious, most severe antisocial acts can be performed.
Status epilepticus - a fixed epileptic state due to a prolonged epileptic seizure or a series of seizures that recur at short intervals. Status epilepticus and recurrent seizures are life-threatening conditions.
Seizures can be a manifestation of genuine ("congenital") and symptomatic epilepsy - a consequence of past diseases (brain injury, cerebrovascular accident, neuro-infection, tumor, tuberculosis, syphilis, toxoplasmosis, cysticercosis, Morgagni-Adams-Stokes syndrome, ventricular fibrillation , eclampsia) and intoxication.
Differential Diagnosis
At the prehospital stage, determining the cause of a seizure is often extremely difficult. The anamnesis and clinical data are of great importance. Special care must be taken with respect to first of all, traumatic brain injury, acute cerebrovascular accidents, cardiac arrhythmias, eclampsia, tetanus and exogenous intoxications.
Urgent Care
1. After a single convulsive seizure - diazepam (Relanium, Seduxen, Sibazon) - 2 ml intramuscularly (as a prevention of recurrent seizures).
2. With a series of convulsive seizures:
Head and torso injury prevention:
Relief of convulsive syndrome: diazepam (Relanium, Seduxen, Sibazon) - 2-4 ml per 10 ml of 0.9% sodium chloride solution intravenously or intramuscularly, Rohypnol 1-2 ml intramuscularly;
In the absence of effect - sodium hydroxybutyrate 20% solution at the rate of 70 mg / kg of body weight intravenously in 5-10% glucose solution;
Decongestant therapy: furosemide (lasix) 40 mg per 10-20 ml of 40% glucose or 0.9% sodium chloride solution (in patients with diabetes mellitus)
intravenously;
Headache relief: analgin 2 ml 50% solution: baralgin 5 ml; tramal 2 ml intravenously or intramuscularly.
3. Status epilepticus
Prevention of trauma to the head and torso;
Restoration of airway patency;
Relief of convulsive syndrome: diazepam (Relanium, Seduxen, Syabazone) _ 2-4 ml per 10 ml of 0.9% sodium chloride solution intravenously or intramuscularly, Rohypnol 1-2 ml intramuscularly;
In the absence of effect - sodium hydroxybutyrate 20% solution at the rate of 70 mg / kg of body weight intravenously in 5-10% glucose solution;
In the absence of effect - inhalation anesthesia nitrous oxide mixed with oxygen (2:1).
Decongestant therapy: furosemide (lasix) 40 mg per 10-20 ml of 40% glucose or 0.9% sodium chloride solution (in diabetic patients) intravenously:
Relief of headache:
Analgin - 2 ml of 50% solution;
- baralgin - 5 ml;
Tramal - 2 ml intravenously or intramuscularly.
According to indications:
With an increase in blood pressure significantly higher than the patient's usual indicators - antihypertensive drugs (clofelin intravenously, intramuscularly or sublingual tablets, dibazol intravenously or intramuscularly);
With tachycardia over 100 beats / min - see "Tachyarrhythmias":
With bradycardia less than 60 beats / min - atropine;
With hyperthermia over 38 ° C - analgin.
Tactics
Patients with the first convulsive seizure in their lives should be hospitalized to find out its cause. In case of refusal of hospitalization with a rapid recovery of consciousness and the absence of cerebral and focal neurological symptoms, an urgent appeal to a neurologist at a polyclinic at the place of residence is recommended. If consciousness is restored slowly, there are cerebral and (or) focal symptoms, then a call for a specialized neurological (neuro-resuscitation) team is indicated, and in its absence, an active visit after 2-5 hours.
Intractable status epilepticus or a series of convulsive seizures is an indication for calling a specialized neurological (neuroresuscitation) team. In the absence of such - hospitalization.
In case of violation of the activity of the heart, which led to a convulsive syndrome, appropriate therapy or a call to a specialized cardiological team. With eclampsia, exogenous intoxication - action according to the relevant recommendations.
Main dangers and complications
Asphyxia during a seizure:
Development of acute heart failure.
Note
1. Aminazine is not an anticonvulsant.
2. Magnesium sulfate and chloral hydrate are not currently available.
3. The use of hexenal or sodium thiopental for the relief of status epilepticus is possible only in the conditions of a specialized team, if there are conditions and the ability to transfer the patient to mechanical ventilation if necessary. (laryngoscope, set of endotracheal tubes, ventilator).
4. With glucalcemic convulsions, calcium gluconate is administered (10-20 ml of a 10% solution intravenously or intramuscularly), calcium chloride (10-20 ml of a 10% solution strictly intravenously).
5. With hypokalemic convulsions, Panangin is administered (10 ml intravenously).
FAINTING (SHORT-TERM LOSS OF CONSCIOUSNESS, SYNCOPE)
Diagnostics
Fainting. - short-term (usually within 10-30 s) loss of consciousness. in most cases accompanied by a decrease in postural vascular tone. Syncope is based on transient hypoxia of the brain, which occurs due to various reasons - a decrease in cardiac output. heart rhythm disturbances, reflex decrease in vascular tone, etc.
Fainting (syncope) conditions can be conditionally divided into two most common forms - vasodepressor (synonyms - vasovagal, neurogenic) syncope, which are based on a reflex decrease in postural vascular tone, and syncope associated with diseases of the heart and great vessels.
Syncopal states have different prognostic significance depending on their genesis. Fainting associated with the pathology of the cardiovascular system can be harbingers of sudden death and require mandatory identification of their causes and adequate treatment. It must be remembered that fainting may be the debut of a severe pathology (myocardial infarction, pulmonary embolism, etc.).
The most common clinical form is vasodepressor syncope, in which there is a reflex decrease in peripheral vascular tone in response to external or psychogenic factors (fear, excitement, type of blood, medical instruments, vein puncture. high temperature environment, staying in a stuffy room, etc.). The development of fainting is preceded by a short prodromal period, during which weakness, nausea, ringing in the ears, yawning, darkening of the eyes, pallor, cold sweat are noted.
If the loss of consciousness is short-term, convulsions are not noted. If fainting lasts more than 15-20 s. clonic and tonic convulsions are noted. During syncope, there is a decrease in blood pressure with bradycardia; or without it. This group also includes syncope that occurs when hypersensitivity carotid sinus, as well as the so-called "situational" syncope - with prolonged cough, defecation, urination. Syncope associated with pathology of cardio-vascular system usually occur suddenly, without a prodromal period. They are divided into two main groups - those associated with cardiac arrhythmias and conduction disorders and those caused by a decrease in cardiac output (stenosis of the aortic orifice. hypertrophic cardiomyopathy, myxoma and spherical blood clots in the atria, myocardial infarction, PE, dissecting aortic aneurysm).
Differential Diagnosis syncope should be carried out with epilepsy, hypoglycemia, narcolepsy, comas various genesis, diseases of the vestibular apparatus, organic pathology of the brain, hysteria.
In most cases, the diagnosis can be made based on a detailed history, physical examination, and ECG recording. To confirm the vasodepressor nature of fainting, positional tests are performed (from simple orthostatic tests to the use of a special inclined table), to increase sensitivity, the tests are performed against the background of drug therapy. If these actions do not clarify the cause of fainting, then a subsequent examination in the hospital is carried out depending on the identified pathology.
In the presence of heart disease: ECG Holter monitoring, echocardiography, electrophysiological examination, positional tests: if necessary, cardiac catheterization.
In the absence of heart disease: positional tests, consultation with a neuropathologist, psychiatrist, ECG Holter monitoring, electroencephalogram, if necessary - computed tomography of the brain, angiography.
Urgent Care
When fainting is usually not required.
The patient must be laid in a horizontal position on his back:
to give the lower limbs an elevated position, to free the neck and chest from restrictive clothing:
Patients should not be seated immediately, as this may lead to a relapse of fainting;
If the patient does not regain consciousness, it is necessary to exclude a traumatic brain injury (if there was a fall) or other causes of prolonged loss of consciousness indicated above.
If syncope is caused by cardiac disease, emergency care may be needed to address the immediate cause of syncope - tachyarrhythmia, bradycardia, hypotension, etc. (see relevant sections).
ACUTE POISONING
Poisoning - pathological conditions caused by the action toxic substances exogenous origin in any way they enter the body.
The severity of the condition in case of poisoning is determined by the dose of the poison, the route of its intake, the time of exposure, the patient's premorbid background, complications (hypoxia, bleeding, convulsive syndrome, acute cardiovascular failure, etc.).
The prehospital doctor needs:
Observe “toxicological alertness” (environmental conditions in which the poisoning occurred, the presence of foreign odors may pose a danger to the ambulance team):
Find out the circumstances that accompanied the poisoning (when, with what, how, how much, for what purpose) in the patient himself, if he is conscious or in those around him;
Collect material evidence (drug packages, powders, syringes), biological media (vomit, urine, blood, wash water) for chemical-toxicological or forensic chemical research;
Register the main symptoms (syndromes) that the patient had before medical care, including mediator syndromes, which are the result of increased or suppressed sympathetic and parasympathetic systems(see Attachment).
GENERAL ALGORITHM FOR PROVIDING EMERGENCY AID
1. Ensure normalization of respiration and hemodynamics (perform basic cardiopulmonary resuscitation).
2. Carry out antidote therapy.
3. Stop further intake of poison into the body. 3.1. In case of inhalation poisoning - remove the victim from the contaminated atmosphere.
3.2. In case of oral poisoning - rinse the stomach, introduce enterosorbents, put a cleansing enema. When washing the stomach or washing off poisons from the skin, use water with a temperature not exceeding 18 ° C; do not carry out the poison neutralization reaction in the stomach! The presence of blood during gastric lavage is not a contraindication for gastric lavage.
3.3. For skin application - wash the affected area of the skin with an antidote solution or water.
4. Start infusion and symptomatic therapy.
5. Transport the patient to the hospital. This algorithm for providing assistance at the prehospital stage is applicable to all types of acute poisoning.
Diagnostics
With mild and moderate severity, an anticholinergic syndrome occurs (intoxication psychosis, tachycardia, normohypotension, mydriasis). In severe coma, hypotension, tachycardia, mydriasis.
Antipsychotics cause the development of orthostatic collapse, prolonged persistent hypotension due to insensitivity of the terminal vascular bed to vasopressors, extrapyramidal syndrome (muscle cramps of the chest, neck, upper shoulder girdle, protrusion of the tongue, bulging eyes), neuroleptic syndrome (hyperthermia, muscle rigidity).
Hospitalization of the patient in a horizontal position. Cholinolytics cause the development of retrograde amnesia.
Opiate poisoning
Diagnostics
Characteristic: oppression of consciousness, to a deep coma. development of apnea, tendencies to bradycardia, injection marks on the elbows.
emergency therapy
Pharmacological antidotes: naloxone (narcanti) 2-4 ml of a 0.5% solution intravenously until spontaneous respiration is restored: if necessary, repeat the administration until mydriasis appears.
Start infusion therapy:
400.0 ml of 5-10% glucose solution intravenously;
Reopoliglyukin 400.0 ml intravenous drip.
Sodium bicarbonate 300.0 ml 4% intravenously;
oxygen inhalation;
In the absence of the effect of the introduction of naloxone, carry out mechanical ventilation in the hyperventilation mode.
Tranquilizer poisoning (benzodiazepine group)
Diagnostics
Characteristic: drowsiness, ataxia, depression of consciousness to coma 1, miosis (in case of poisoning with noxiron - mydriasis) and moderate hypotension.
Tranquilizers of the benzodiazepine series cause deep depression of consciousness only in “mixed” poisonings, i.e. in combination with barbiturates. neuroleptics and other sedative-hypnotic drugs.
emergency therapy
Follow steps 1-4 of the general algorithm.
For hypotension: reopoliglyukin 400.0 ml intravenously, drip:
Barbiturate poisoning
Diagnostics
Miosis, hypersalivation, "greasiness" of the skin, hypotension, deep depression of consciousness up to the development of coma are determined. Barbiturates cause a rapid breakdown of tissue trophism, the formation of bedsores, the development of the syndrome positional pressure, pneumonia.
Urgent Care
Pharmacological antidotes (see note).
Run point 3 of the general algorithm;
Start infusion therapy:
Sodium bicarbonate 4% 300.0, intravenous drip:
Glucose 5-10% 400.0 ml intravenously;
Sulfocamphocaine 2.0 ml intravenously.
oxygen inhalation.
POISONING WITH DRUGS OF STIMULANT ACTION
These include antidepressants, psychostimulants, general tonic (tinctures, including alcohol ginseng, eleutherococcus).
Delirium, hypertension, tachycardia, mydriasis, convulsions, cardiac arrhythmias, ischemia and myocardial infarction are determined. They have an oppression of consciousness, hemodynamics and respiration after the phase of excitation and hypertension.
Poisoning occurs with adrenergic (see Appendix) syndrome.
Poisoning with antidepressants
Diagnostics
With a short duration of action (up to 4-6 hours), hypertension is determined. delirium. dryness of the skin and mucous membranes, expansion of the 9K8 complex on the ECG (quinidine-like effect of tricyclic antidepressants), convulsive syndrome.
With prolonged action (more than 24 hours) - hypotension. urinary retention, coma. Always mydriasis. dryness of the skin, expansion of the OK8 complex on the ECG: Antidepressants. serotonin blockers: fluoxentine (Prozac), fluvoxamine (paroxetine), alone or in combination with analgesics, can cause “malignant” hyperthermia.
Urgent Care
Follow point 1 of the general algorithm. For hypertension and agitation:
Short-acting drugs with a rapidly onset effect: galantamine hydrobromide (or nivalin) 0.5% - 4.0-8.0 ml, intravenously;
Preparations long-acting: aminostigmine 0.1% - 1.0-2.0 ml intramuscularly;
In the absence of antagonists - anticonvulsants: relanium (seduxen), 20 mg per - 20.0 ml of 40% glucose solution intravenously; or sodium oxybutyrate 2.0 g per - 20.0 ml of 40.0% glucose solution intravenously, slowly);
Follow point 3 of the general algorithm. Start infusion therapy:
In the absence of sodium bicarbonate - trisol (disol. Chlosol) 500.0 ml intravenously, drip.
With severe arterial hypotension:
Reopoliglyukin 400.0 ml intravenously, drip;
Norepinephrine 0.2% 1.0 ml (2.0) in 400 ml of 5-10% glucose solution intravenously, drip, increase the rate of administration until blood pressure stabilizes.
POISONING WITH ANTI-TUBERCULOSIS DRUGS (ISONIAZIDE, FTIVAZIDE, TUBAZIDE)
Diagnostics
Characteristic: generalized convulsive syndrome, development of stunning. up to coma, metabolic acidosis. Any convulsive syndrome resistant to benzodiazepine treatment should alert for isoniazid poisoning.
Urgent Care
Run point 1 of the general algorithm;
With convulsive syndrome: pyridoxine up to 10 ampoules (5 g). intravenous drip for 400 ml of 0.9% sodium chloride solution; Relanium 2.0 ml, intravenously. before relief of the convulsive syndrome.
If there is no result, muscle relaxants of antidepolarizing action (arduan 4 mg), tracheal intubation, mechanical ventilation.
Follow point 3 of the general algorithm.
Start infusion therapy:
Sodium bicarbonate 4% 300.0 ml intravenously, drip;
Glucose 5-10% 400.0 ml intravenously, drip. With arterial hypotension: reopoliglyukin 400.0 ml intravenously. drip.
Early detoxification hemosorption is effective.
POISONING WITH TOXIC ALCOHOL (METHANOL, ETHYLENE GLYCOL, CELLOSOLVES)
Diagnostics
Characteristic: the effect of intoxication, decreased visual acuity (methanol), abdominal pain (propyl alcohol; ethylene glycol, cellosolva with prolonged exposure), depression of consciousness to deep coma, decompensated metabolic acidosis.
Urgent Care
Run point 1 of the general algorithm:
Run point 3 of the general algorithm:
Ethanol is the pharmacological antidote for methanol, ethylene glycol, and cellosolves.
Initial therapy with ethanol (saturation dose per 80 kg of the patient's body weight, at the rate of 1 ml of a 96% alcohol solution per 1 kg of body weight). To do this, dilute 80 ml of 96% alcohol with water in half, give a drink (or enter through a probe). If it is impossible to prescribe alcohol, 20 ml of a 96% alcohol solution is dissolved in 400 ml of a 5% glucose solution and the resulting alcohol solution glucose is injected into a vein at a rate of 100 drops / min (or 5 ml of solution per minute).
Start infusion therapy:
Sodium bicarbonate 4% 300 (400) intravenously, drip;
Acesol 400 ml intravenously, drip:
Hemodez 400 ml intravenously, drip.
When transferring a patient to a hospital, indicate the dose, time and route of administration of the ethanol solution at the prehospital stage to provide a maintenance dose of ethanol (100 mg/kg/hour).
ETHANOL POISONING
Diagnostics
Determined: depression of consciousness to a deep coma, hypotension, hypoglycemia, hypothermia, cardiac arrhythmias, respiratory depression. Hypoglycemia, hypothermia lead to the development of cardiac arrhythmias. In alcoholic coma, the lack of response to naloxone may be due to concomitant traumatic brain injury (subdural hematoma).
Urgent Care
Follow steps 1-3 of the general algorithm:
With depression of consciousness: naloxone 2 ml + glucose 40% 20-40 ml + thiamine 2.0 ml intravenously slowly. Start infusion therapy:
Sodium bicarbonate 4% 300-400 ml intravenously;
Hemodez 400 ml intravenous drip;
Sodium thiosulfate 20% 10-20 ml intravenously slowly;
Unithiol 5% 10 ml intravenously slowly;
Ascorbic acid 5 ml intravenously;
Glucose 40% 20.0 ml intravenously.
When excited: Relanium 2.0 ml intravenously slowly in 20 ml of 40% glucose solution.
Withdrawal state caused by alcohol consumption
When examining a patient at the prehospital stage, it is advisable to adhere to certain sequences and principles of emergency care for acute alcohol poisoning.
Establish the fact of recent alcohol intake and determine its characteristics (date of last intake, binge or single intake, quantity and quality of alcohol consumed, total duration of regular alcohol intake). Can be corrected for social status sick.
· Establish the fact of chronic alcohol intoxication, the level of nutrition.
Determine the risk of developing a withdrawal syndrome.
· As part of toxic visceropathy, to determine: the state of consciousness and mental functions, to identify gross neurological disorders; the stage of alcoholic liver disease, the degree of liver failure; identify damage to other target organs and the degree of their functional usefulness.
Determine the prognosis of the condition and develop a plan for monitoring and pharmacotherapy.
It is obvious that the clarification of the patient's "alcohol" history is aimed at determining the severity of the current acute alcohol poisoning, as well as the risk of developing alcohol withdrawal syndrome (3-5 days after the last alcohol intake).
In the treatment of acute alcohol intoxication, a set of measures is needed aimed, on the one hand, at stopping the further absorption of alcohol and its accelerated removal from the body, and on the other hand, at protecting and maintaining systems or functions that suffer from the effects of alcohol.
The intensity of therapy is determined both by the severity of acute alcohol intoxication and the general condition of the intoxicated person. In this case, gastric lavage is carried out in order to remove alcohol that has not yet been absorbed, and drug therapy detoxification agents and alcohol antagonists.
In the treatment of alcohol withdrawal the doctor takes into account the severity of the main components of the withdrawal syndrome (somato-vegetative, neurological and mental disorders). Mandatory components are vitamin and detoxification therapy.
Vitamin therapy includes parenteral administration of solutions of thiamine (Vit B1) or pyridoxine hydrochloride (Vit B6) - 5-10 ml. With severe tremor, a solution of cyanocobalamin (Vit B12) is prescribed - 2-4 ml. The simultaneous administration of various B vitamins is not recommended due to the possibility of enhancing allergic reactions and their incompatibility in one syringe. Ascorbic acid (Vit C) - up to 5 ml is administered intravenously along with plasma-substituting solutions.
Detoxification therapy includes the introduction of thiol preparations - a 5% solution of unitiol (1 ml per 10 kg of body weight intramuscularly) or a 30% solution of sodium thiosulfate (up to 20 ml); hypertonic - 40% glucose - up to 20 ml, 25% magnesium sulfate(up to 20 ml), 10% calcium chloride (up to 10 ml), isotonic - 5% glucose (400-800 ml), 0.9% sodium chloride solution (400-800 ml) and plasma-substituting - gemodez (200-400 ml ) solutions. It is also advisable, intravenous administration of a 20% solution of piracetam (up to 40 ml).
These measures, according to indications, are supplemented by the relief of somato-vegetative, neurological and mental disorders.
With an increase in blood pressure, 2-4 ml of a solution of papaverine hydrochloride or dibazol is injected intramuscularly;
In case of heart rhythm disturbance, analeptics are prescribed - a solution of cordiamine (2-4 ml), camphor (up to 2 ml), potassium preparations panangin (up to 10 ml);
With shortness of breath, difficulty breathing - up to 10 ml of a 2.5% solution of aminophylline is injected intravenously.
A decrease in dyspeptic phenomena is achieved by introducing a solution of raglan (cerucal - up to 4 ml), as well as spasmalgesics - baralgin (up to 10 ml), NO-ShPy (up to 5 ml). A solution of baralgin, along with a 50% solution of analgin, is also indicated to reduce the severity of headaches.
With chills, sweating, a solution of nicotinic acid (Vit PP - up to 2 ml) or a 10% solution of calcium chloride - up to 10 ml is injected.
Psychotropic drugs are used to stop affective, psychopathic and neurosis-like disorders. Relanium (dizepam, seduxen, sibazon) is administered intramuscularly, or at the end of intravenous infusion of solutions intravenously at a dose of up to 4 ml for withdrawal symptoms with anxiety, irritability, sleep disorders, autonomic disorders. Nitrazepam (eunoctin, radedorm - up to 20 mg), phenazepam (up to 2 mg), grandaxin (up to 600 mg) are given orally, it should be borne in mind that nitrazepam and phenazepam are best used to normalize sleep, and grandaxin for stopping autonomic disorders.
When expressed affective disorders(irritability, a tendency to dysphoria, outbursts of anger), antipsychotics with a hypnotic-sedative effect are used (droperidol 0.25% - 2-4 ml).
With rudimentary visual or auditory hallucinations, paranoid mood in the structure of abstinence, 2-3 ml of a 0.5% solution of haloperidol is intramuscularly injected in combination with Relanium to reduce neurological side effects.
With pronounced restlessness applied droperidol 2-4 ml of 0.25% solution intramuscularly or sodium oxybutyrate 5-10 ml of 20% solution intravenously. Antipsychotics from the group of phenothiazines (chlorpromazine, tizercin) and tricyclic antidepressants (amitriptyline) are contraindicated.
Therapeutic measures are carried out until there are signs of a clear improvement in the patient's condition (reduction of somato-vegetative, neurological, mental disorders, normalization of sleep) under constant monitoring of the function of the cardiovascular or respiratory system.
pacing
Cardiac pacing (ECS) is a method by which external electrical impulses produced by an artificial pacemaker (pacemaker) are applied to any part of the heart muscle, as a result of which the heart contracts.
Indications for pacing
· Asystole.
Severe bradycardia regardless of the underlying cause.
· Atrioventricular or Sinoatrial blockade with attacks of Adams-Stokes-Morgagni.
There are 2 types of pacing: permanent pacing and temporary pacing.
1. Permanent pacing
Permanent pacing is the implantation of an artificial pacemaker or cardioverter-defibrillator. Temporary pacing
2. Temporary pacing is necessary for severe bradyarrhythmias due to sinus node dysfunction or AV block.
Temporary pacing can be carried out by various methods. Currently relevant are transvenous endocardial and transesophageal pacing, and in some cases, external transcutaneous pacing.
Transvenous (endocardial) pacing has received especially intensive development, since it is the only effective way“impose” an artificial rhythm on the heart when severe violations systemic or regional circulation due to bradycardia. When it is performed, the electrode under ECG control through the subclavian, internal jugular, ulnar or femoral vein injected into the right atrium or right ventricle.
Temporary atrial transesophageal pacing and transesophageal ventricular pacing (TEPS) have also become widespread. TSES is used as a replacement therapy for bradycardia, bradyarrhythmias, asystole, and sometimes for reciprocal supraventricular arrhythmias. It is often used with diagnostic purpose. Temporary transthoracic pacing is sometimes used by emergency physicians to buy time. One electrode is inserted through a percutaneous puncture into the heart muscle, and the second is a needle placed subcutaneously.
Indications for temporary pacing
· Temporary pacing is carried out in all cases of indications for permanent pacing as a "bridge" to it.
Temporary pacing is performed when it is not possible to urgently implant a pacemaker.
Temporary pacing is carried out with hemodynamic instability, primarily in connection with Morgagni-Edems-Stokes attacks.
Temporary pacing is performed when there is reason to believe that bradycardia is transient (with myocardial infarction, the use of drugs that can inhibit the formation or conduction of impulses, after cardiac surgery).
Temporary pacing is recommended for the prevention of patients with acute myocardial infarction of the anterior septal region of the left ventricle with blockade of the right and anterior superior branch of the left branch of the bundle of His, due to the increased risk of developing a complete atrioventricular block with asystole due to the unreliability of the ventricular pacemaker in this case.
Complications of temporary pacing
Displacement of the electrode and the impossibility (cessation) of electrical stimulation of the heart.
Thrombophlebitis.
· Sepsis.
Air embolism.
Pneumothorax.
Perforation of the wall of the heart.
Cardioversion-defibrillation
Cardioversion-defibrillation (electropulse therapy - EIT) - is a transsternal effect of direct current of sufficient strength to cause depolarization of the entire myocardium, after which the sinoatrial node (first-order pacemaker) resumes control of the heart rhythm.
Distinguish between cardioversion and defibrillation:
1. Cardioversion - exposure to direct current, synchronized with the QRS complex. With various tachyarrhythmias (except for ventricular fibrillation), the effect of direct current should be synchronized with the QRS complex, because. in the case of current exposure before the peak of the T wave, ventricular fibrillation may occur.
2. Defibrillation. The impact of direct current without synchronization with the QRS complex is called defibrillation. Defibrillation is performed in ventricular fibrillation, when there is no need (and no opportunity) to synchronize the exposure to direct current.
Indications for cardioversion-defibrillation
Flutter and ventricular fibrillation. Electropulse therapy is the method of choice. Read more: Cardiopulmonary resuscitation at a specialized stage in the treatment of ventricular fibrillation.
Persistent ventricular tachycardia. In the presence of impaired hemodynamics (Morgagni-Adams-Stokes attack, arterial hypotension and / or acute heart failure), defibrillation is carried out immediately, and if it is stable, after an attempt to stop it with medications if it is ineffective.
Supraventricular tachycardia. Electropulse therapy is performed according to vital indications with progressive deterioration of hemodynamics or in a planned manner with the ineffectiveness of drug therapy.
· Atrial fibrillation and flutter. Electropulse therapy is performed according to vital indications with progressive deterioration of hemodynamics or in a planned manner with the ineffectiveness of drug therapy.
· Electropulse therapy is more effective in reentry tachyarrhythmias, less effective in tachyarrhythmias due to increased automatism.
· Electropulse therapy is absolutely indicated for shock or pulmonary edema caused by tachyarrhythmia.
Emergency electropulse therapy is usually performed in cases of severe (more than 150 per minute) tachycardia, especially in patients with acute myocardial infarction, with unstable hemodynamics, persistent anginal pain, or contraindications to the use of antiarrhythmic drugs.
All ambulance teams and all units of medical institutions should be equipped with a defibrillator, and all medical workers should be proficient in this method of resuscitation.
Cardioversion-defibrillation technique
In the case of a planned cardioversion, the patient should not eat for 6-8 hours to avoid possible aspiration.
Due to the pain of the procedure and the fear of the patient, general anesthesia or intravenous analgesia and sedation are used (for example, fentanyl at a dose of 1 mcg / kg, then midazolam 1-2 mg or diazepam 5-10 mg; elderly or debilitated patients - 10 mg promedol). With initial respiratory depression, non-narcotic analgesics are used.
When performing cardioversion-defibrillation, you must have the following kit on hand:
· Tools for maintaining airway patency.
· Electrocardiograph.
· Artificial lung ventilation apparatus.
Medications and solutions required for the procedure.
· Oxygen.
The sequence of actions during electrical defibrillation:
The patient should be in a position that allows, if necessary, to carry out tracheal intubation and closed heart massage.
Reliable access to the patient's vein is required.
· Turn on the power, turn off the defibrillator timing switch.
· Set the required charge on the scale (approximately 3 J/kg for adults, 2 J/kg for children); charge the electrodes; lubricate the plates with gel.
· It is more convenient to work with two manual electrodes. Install electrodes on the anterior surface of the chest:
One electrode is placed above the zone of cardiac dullness (in women - outward from the apex of the heart, outside the mammary gland), the second - under the right clavicle, and if the electrode is dorsal, then under the left shoulder blade.
The electrodes can be placed in the anteroposterior position (along the left edge of the sternum in the area of the 3rd and 4th intercostal spaces and in the left subscapular region).
The electrodes can be placed in the anterolateral position (between the clavicle and the 2nd intercostal space along the right edge of the sternum and above the 5th and 6th intercostal spaces, in the region of the apex of the heart).
· For maximum reduction of electrical resistance during electropulse therapy, the skin under the electrodes is degreased with alcohol or ether. In this case, gauze pads are used, well moistened with isotonic sodium chloride solution or special pastes.
The electrodes are pressed against the chest wall tightly and with force.
Perform cardioversion-defibrillation.
The discharge is applied at the moment of complete exhalation of the patient.
If the type of arrhythmia and the type of defibrillator allow, then the shock is delivered after synchronization with the QRS complex on the monitor.
Immediately before applying the discharge, you should make sure that the tachyarrhythmia persists, for which electrical impulse therapy is performed!
With supraventricular tachycardia and atrial flutter, a discharge of 50 J is sufficient for the first exposure. With atrial fibrillation or ventricular tachycardia, a discharge of 100 J is required for the first exposure.
In the case of polymorphic ventricular tachycardia or ventricular fibrillation, a discharge of 200 J is used for the first exposure.
While maintaining arrhythmia, with each subsequent discharge, the energy is doubled up to a maximum of 360 J.
The time interval between attempts should be minimal and is required only to assess the effect of defibrillation and set, if necessary, the next discharge.
If 3 discharges with increasing energy did not restore the heart rhythm, then the fourth - maximum energy - is applied after the intravenous administration of an antiarrhythmic drug indicated for this type of arrhythmia.
· Immediately after electropulse therapy, the rhythm should be assessed and, if it is restored, an ECG should be recorded in 12 leads.
If ventricular fibrillation continues, antiarrhythmic drugs are used to lower the defibrillation threshold.
Lidocaine - 1.5 mg / kg intravenously, by stream, repeat after 3-5 minutes. In case of restoration of blood circulation, a continuous infusion of lidocaine is carried out at a rate of 2-4 mg / min.
Amiodarone - 300 mg intravenously over 2-3 minutes. If there is no effect, you can repeat the intravenous administration of another 150 mg. In case of restoration of blood circulation, continuous infusion is carried out in the first 6 hours 1 mg / min (360 mg), in the next 18 hours 0.5 mg / min (540 mg).
Procainamide - 100 mg intravenously. If necessary, the dose can be repeated after 5 minutes (up to a total dose of 17 mg/kg).
Magnesium sulfate (Kormagnesin) - 1-2 g intravenously over 5 minutes. If necessary, the introduction can be repeated after 5-10 minutes. (with tachycardia of the "pirouette" type).
After the introduction of the drug for 30-60 seconds, general resuscitation is carried out, and then the electrical impulse therapy is repeated.
In case of intractable arrhythmias or sudden cardiac death, it is recommended to alternate the administration of drugs with electropulse therapy according to the scheme:
Antiarrhythmic drug - shock 360 J - adrenaline - shock 360 J - antiarrhythmic drug - shock 360 J - adrenaline, etc.
· You can apply not 1, but 3 discharges of maximum power.
· The number of digits is not limited.
In case of ineffectiveness, general resuscitation measures are resumed:
Perform tracheal intubation.
Provide venous access.
Inject adrenaline 1 mg every 3-5 minutes.
You can enter increasing doses of adrenaline 1-5 mg every 3-5 minutes or intermediate doses of 2-5 mg every 3-5 minutes.
Instead of adrenaline, you can enter intravenously vasopressin 40 mg once.
Defibrillator Safety Rules
Eliminate the possibility of grounding the personnel (do not touch the pipes!).
Exclude the possibility of touching others to the patient during the application of the discharge.
Make sure that the insulating part of the electrodes and hands are dry.
Complications of cardioversion-defibrillation
· Post-conversion arrhythmias, and above all - ventricular fibrillation.
Ventricular fibrillation usually develops when a shock is applied during a vulnerable phase of the cardiac cycle. The probability of this is low (about 0.4%), however, if the patient's condition, the type of arrhythmia and technical capabilities allow, synchronization of the discharge with the R wave on the ECG should be used.
If ventricular fibrillation occurs, a second discharge with an energy of 200 J is immediately applied.
Other post-conversion arrhythmias (eg, atrial and ventricular extrasystoles) are usually transient and do not require special treatment.
Thromboembolism of the pulmonary artery and systemic circulation.
Thromboembolism often develops in patients with thromboendocarditis and with long-term atrial fibrillation in the absence of adequate preparation with anticoagulants.
Respiratory disorders.
Respiratory disorders are the result of inadequate premedication and analgesia.
To prevent the development of respiratory disorders, full oxygen therapy should be carried out. Often, developing respiratory depression can be dealt with with the help of verbal commands. Do not try to stimulate breathing with respiratory analeptics. In severe respiratory failure, intubation is indicated.
skin burns.
Skin burns occur due to poor contact of the electrodes with the skin, the use of repeated discharges with high energy.
Arterial hypotension.
Arterial hypotension after cardioversion-defibrillation rarely develops. Hypotension is usually mild and does not last long.
· Pulmonary edema.
Pulmonary edema occasionally occurs 1-3 hours after the restoration of sinus rhythm, especially in patients with long-term atrial fibrillation.
Changes in repolarization on the ECG.
Changes in repolarization on the ECG after cardioversion-defibrillation are multidirectional, non-specific, and can persist for several hours.
· Changes in biochemical analysis blood.
Increases in the activity of enzymes (AST, LDH, CPK) are mainly associated with the effect of cardioversion-defibrillation on skeletal muscles. The CPK MV activity increases only with multiple high-energy discharges.
Contraindications for EIT:
1. Frequent, short-term paroxysms of AF, which stop on their own or with medication.
2. Permanent form of atrial fibrillation:
More than three years old
The age is not known.
cardiomegaly,
Frederick Syndrome,
glycosidic toxicity,
TELA up to three months,
LIST OF USED LITERATURE
1. A.G. Miroshnichenko, V.V. Ruksin St. Petersburg Medical Academy of Postgraduate Education, St. Petersburg, Russia "Protocols of the treatment and diagnostic process at the prehospital stage"
2. http://smed.ru/guides/67158/#Pokazaniya_k_provedeniju_kardioversiidefibrillyacii
3. http://smed.ru/guides/67466/#_Pokazaniya_k_provedeniju_jelektrokardiostimulyacii
4. http://cardiolog.org/cardiohirurgia/50-invasive/208-vremennaja-ecs.html
5. http://www.popumed.net/study-117-13.html
Sometimes children have emergencies in which emergency medical care is not only desirable, but vital. Panic and fear for your child in these cases are bad helpers: tears, oohs, sighs and other lamentations will not help the cause. It is necessary to act, abstracting from personal experiences, clearly, coordinated, following a strictly prescribed algorithm.
In the event of unforeseen circumstances related to the health of the child, he should always be examined by a doctor. But the doctor has no wings, he cannot appear instantly. And the first 10 minutes often determine whether a given situation backfires or you quickly forget about the episode. Therefore, this chapter gives advice on how to provide first aid to a child: what and in what sequence should be done before the doctor arrives.
Features of emergency care for children with hyperthermia
Elevated temperature (hyperthermia) occurs in many diseases. It is necessary to distinguish between "red" and "white" hyperthermia.
"Red" disturbs the child to a lesser extent, the skin is reddened, the hands and feet are warm to the touch. "White" children tolerate worse; they become lethargic, the skin is pale, and the hands and feet are cold.
Fighting "red" hyperthermia is much easier. Providing first aid, children are given paracetamol preparations such as Efferalgan, Panadol, Kalpol, paracetamol, Cefekon suppositories and others with a similar effect. Syrups "Nise", "Nurofen" have a more pronounced anti-inflammatory effect.
Also, emergency care for children with hyperthermia includes physical cooling: the child must be undressed, put a cold compress on the forehead, the body must be wiped with a sponge moistened with cool (20 degrees) water with vinegar (1 tablespoon of vinegar per 1 liter of water), and also give plenty of warm drink. The procedure can be repeated several times in a row until the temperature drops to 38 °C. Paracetamol is given to the child again after 5-6 hours.
With "white" hyperthermia, you also need to make a cold compress on the forehead, you can give the child "No-shpu" or "Papaverine" and at the same time an antihistamine drug ("Tavegil", "Suprastin", "Fenistil", "Fenkarol", "Claritin", "Zirtek"), as well as antipyretics (paracetamol, etc.).
When providing assistance in such an emergency, it is impossible to wipe children, on the contrary, you need to warm the child (warmers to the arms and legs, put woolen socks on the child, give a plentiful hot drink) and wait until the legs become warm and the skin turns pink. Only after that you can carry out vodka rubdown.
If the child remains pale, and the temperature does not decrease, it is imperative to call emergency care.
How to provide first aid to a child with false croup
Acute stenosing laryngotracheitis () develops most often suddenly, at night. The child goes to bed outwardly quite healthy, and at night completely unexpectedly wakes up excited. He has a loud "barking" cough, hoarseness of voice, shortness of breath (inhalation is more difficult).
The cause of false croup can be viral infections (parainfluenza viruses, adenoviruses, and others) or an allergic lesion of the larynx. Urgent measures are carried out in the same way, regardless of the cause.
The emergency care algorithm for children begins with calming the child. Then give him warmed Borjomi mineral water or other alkaline heated water, it is very good to give the child at this moment a mixture of warm milk (2/3) and Borjomi (1/3).
If there is an inhaler (nebulizer) in the house, inhale Naphthyzinum 0.05%: 1 ml of the drug per 1 ml of saline or warm water. If you have "Naphthyzin" 0.1%, then it is diluted in a proportion of 1 ml of the drug to 2 ml of water. Repeated inhalation can be carried out after 4-5 hours. In the absence of an inhaler at home, drip Naphthyzin into the nose (2-3 drops in each nostril).
When providing emergency emergency care to children, ventilate the room well, as cold air reduces swelling of the mucous membranes. It is more difficult for a child to breathe in a warm stuffy room.
Shown are antihistamines with a minimally drying effect, such as Zyrtec and Claritin.
If it is not possible to quickly call an ambulance, all these emergency care activities for children at the pre-hospital stage are carried out by parents. A doctor's examination in such a situation is required.
Providing first aid to children with abdominal pain and poisoning
Stomach ache
For any pain in the abdomen that has arisen for the first time, it is absolutely impossible to give the child any medicine, in no case should a heating pad be placed on the stomach. At acute appendicitis and other acute diseases of the abdominal cavity, taking medications can drown out external symptoms, but the disease itself will progress. Medicines in the provision of emergency care to children can be given only if there has been an exacerbation of chronic diseases and only those that have already been prescribed by the attending physician. If the child has abdominal pain for the first time, he must be examined by a doctor, and as soon as possible.
drug poisoning
Almost every medicine in a large dose is a poison! Therefore, all medicines and household chemicals should be kept out of the reach of children, preferably even under lock and key. If the child still ate something that should not be eaten, try to make him vomit and rinse the stomach with cold water ( plentiful drink). After that, for emergency medical care, it is advisable for children to give some kind of enterosorbent (Polyphepan, Enterosgel, activated charcoal, etc.).
Better to call an ambulance. Moreover, a seemingly harmless drug can cause severe poisoning.
Emergency first aid for children with injuries and bruises
In young children, injuries are very common. Curiosity is inherent in the kid, he constantly strives to learn something new, and dangers lie in wait for him along the way. A child may run into furniture with a run, may fall from a bed, chair, table. To prevent this from happening, try not to leave small children unattended. It is impossible to predict when a small child will first roll over, sit up or start crawling. Often, parents of children who have fallen out of bed or a changing table can be heard: “He hasn’t rolled over before!” Children grow and develop, and if the baby did not do it yesterday or today, this does not mean that he will not be able to do it tomorrow. The child can only be left alone in a crib or playpen. When he starts to try to sit up on his own, you must immediately lower the bottom of the crib. And of course, you need to be on the lookout when the child begins to walk. What algorithm for providing emergency care to children should be followed in case of injuries?
After a long winter, we all love to get out into nature, out of the city. But there we are waiting for mosquitoes and midges. Their bites are especially dangerous for young children, who have sensitive skin, and besides, they cannot protect themselves from these insects. So kids need help.
Firstly, the room where the child spends the night should have mosquito nets on the windows and doors. Secondly, fumigators with special tablets can be used indoors. Third, remember that insects fly towards the light. Therefore, if you turn on the electricity in the evening, then make sure that insects do not have access to the room where the child will sleep.
It's harder on the street. The use of repellents (substances that repel insects) is undesirable for young children. In extreme cases, some of them (those that are not contraindicated in children) can be applied to clothing. But if the child is still bitten by mosquitoes and itchy spots appear on the skin, then treat them with Fenistil gel, which reduces swelling and itching. A good result when helping children is the use of an ordinary soda solution (1 teaspoon per 1 glass of water), it also reduces itching.
tick bites
The encephalitic tick is a carrier of two diseases: tick-borne encephalitis and tick-borne borreliosis (Lyme disease). Approximately every hundredth tick carries a virus, and every tenth - Borrelia. So that ticks do not spoil your vacation, it is advisable, when going out into nature, to dress in such a way that the tick cannot reach the skin. Ticks wake up at the end of April, and it is from this time that security measures must be taken. If the tick still bit the child, then during the first emergency medical care, it is necessary to administer anti-tick gamma globulin to the victim in the first 48 hours after the bite. It is also advisable to examine the tick for the presence of Borrelia, so do not try to immediately throw it away, even if you removed it yourself, take it to the laboratory for research. The fact is that anti-tick gamma globulin protects only against the tick-borne encephalitis virus. If the tick also contained Borrelia, then antibiotic therapy, since Lyme disease is very long and quite difficult. Can climb those
temperature, joints and skin become inflamed at the site of the bite.
Returning from a walk, do not forget to inspect the clothes and skin of the child, because the tick could get on him, but not yet stick.
In order not to have to resort to providing first aid to children, do not forget about vaccination. The vaccination against tick-borne encephalitis, which everyone remembers in the summer, can only be done from November to March, when all the ticks are sleeping. For the first time, the child is given 2 vaccinations with an interval of 1 month, and a year later the child is vaccinated once. This vaccine is given to children from 4 years of age.
Do not forget: proper first aid for emergency conditions in children, may have crucial how quickly your baby will recover.
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Article 11 Federal Law No. 323-FZ dated November 21, 2011“On the fundamentals of protecting the health of citizens in the Russian Federation” (hereinafter referred to as Federal Law No. 323) says that in an emergency form it is provided by a medical organization and a medical worker to a citizen immediately and free of charge. Refusal to provide it is not allowed. A similar wording was in the old Fundamentals of Legislation on the Protection of the Health of Citizens in the Russian Federation (approved by the Supreme Court of the Russian Federation on 07/22/1993 N 5487-1, became invalid from 01/01/2012), although the concept "" appeared in it. What is emergency medical care and what is its difference from the emergency form?
An attempt to isolate emergency medical care from emergency or emergency medical care familiar to each of us was previously made by officials of the Ministry of Health and Social Development of Russia (since May 2012 -). Therefore, approximately since 2007, we can talk about the beginning of some separation or differentiation of the concepts of "emergency" and "urgent" care at the legislative level.
However, in the explanatory dictionaries of the Russian language there are no clear differences between these categories. Urgent - one that cannot be postponed; urgent. Urgent - urgent, emergency, urgent. Federal Law No. 323 put an end to this issue by approving three different forms of medical care: emergency, urgent and planned.
emergency
Medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases that threaten the patient's life.
urgent
Medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient's life.
Planned
Medical assistance that is provided during preventive measures, in case of diseases and conditions that are not accompanied by a threat to the life of the patient, that do not require emergency and urgent medical care, and the delay in the provision of which for a certain time will not entail a deterioration in the patient's condition, a threat to his life and health.
As you can see, emergency and emergency medical care are opposed to each other. At the moment, absolutely any medical organization is obliged to provide only emergency medical care free of charge and without delay. So are there any significant differences between the two concepts under discussion?
The main difference is that the EMF appears in cases constituting life threatening person, and urgent - without obvious signs of a threat to life. However, the problem lies in the fact that the legislation does not clearly define which cases and conditions are considered a threat, and which are not. Moreover, it is not clear what is considered a clear threat? Diseases, pathological conditions, signs that indicate a threat to life are not described. The mechanism for determining the threat is not indicated. Among other things, the condition may not be a life-threatening condition at a particular moment, but failure to provide assistance will lead to a life-threatening condition in the future.
In view of this, a completely fair question arises: how to distinguish a situation when emergency care is needed, how to draw a line between emergency and emergency care. An excellent example of the difference between emergency and emergency care is indicated in the article by Professor A.A. Mokhova "Features of legislative regulation of the provision of emergency and urgent care in Russia":
| sign | Medical Assistance Form | |
|---|---|---|
| emergency | urgent | |
| Medical criterion | life threat | There is no obvious threat to life |
| Basis for assistance | Patient's request for help (expression of will; contractual regime); conversion of other persons (lack of will; legal regime) | Appeal of the patient (his legal representatives) for help (contractual mode) |
| Conditions of rendering | Outside the medical organization ( prehospital stage); in a medical organization (hospital stage) | Outpatient (including at home), as part of a day hospital |
| Person responsible for providing medical care | Physician or paramedic, any healthcare professional | Medical specialist (therapist, surgeon, ophthalmologist, etc.) |
| Time interval | Help must be provided as soon as possible. | Assistance must be provided within a reasonable time |
But unfortunately, this is also not enough. In this matter, it is unequivocally impossible to do without the participation of our "legislators". The solution of the problem is necessary not only for theory, but also for "practice". One of the reasons, as mentioned earlier, is the obligation of each medical organization to provide free medical care in an emergency form, while emergency care can be provided on a paid basis.
It is important to note that the "image" of emergency medical care is still "collective". One of the reasons is territorial programs of state guarantees of free provision of medical care to citizens (hereinafter referred to as TPSG), which contain (or do not contain) various provisions regarding the procedure and conditions for the provision of EMT, urgency criteria, the procedure for reimbursement of expenses for the provision of EMT, and so on.
For example, TPPG 2018 Sverdlovsk region indicates that an emergency case must meet the criteria for an emergency: suddenness, acute condition, life-threatening. Some TPGG mention the criteria of urgency, referring to the Order of the Ministry of Health and Social Development of the Russian Federation dated April 24, 2008 No. 194n “On approval of the Medical criteria for determining the severity of harm caused to human health” (hereinafter - Order No. 194n). For example, TPSG 2018 of the Perm Territory indicates that the criterion for the urgency of medical care is the presence of life-threatening conditions defined in:
- Clause 6.1 of Order No. 194n (harm to health, dangerous to human life, which by its nature directly poses a threat to life, as well as harm to health that caused the development of a life-threatening condition, namely: a head wound; contusion of the cervical spinal cord with a violation of its functions, etc.*);
- clause 6.2 of Order No. 194n (harm to health, dangerous to human life, causing a disorder in the vital functions of the human body, which cannot be compensated by the body on its own and usually ends in death, namely: severe III-IV degree shock; acute, profuse or massive blood loss, etc. *).
* The full list is defined in Order No. 194n.
According to ministry officials, emergency medical care is provided if the available pathological changes the patient is not life threatening. But from various regulatory legal acts of the Ministry of Health and Social Development of Russia, it follows that there are no significant differences between emergency and emergency medical care.
Some TPSG indicate that the provision of medical care in an emergency form is carried out in accordance with emergency medical care standards, approved by orders of the Ministry of Health of Russia, according to conditions, syndromes, diseases. And, for example, TPSG 2018 of the Sverdlovsk Region means that emergency care is provided on an outpatient, inpatient and day hospital basis in the following cases:
- in the event of an emergency condition in a patient on the territory of a medical organization (when a patient seeks medical care in a planned form, for carrying out diagnostic tests, consultations);
- when a patient independently applies or is delivered to a medical organization (as the closest one) by relatives or other persons in the event of an emergency;
- in the event of an emergency condition in a patient at the time of treatment in a medical organization, carrying out planned manipulations, operations, studies.
Among other things, it is important to note that in case of a citizen’s health condition requiring emergency medical care, the citizen’s examination and therapeutic measures are carried out at the place of his appeal immediately by the medical worker to whom he applied.
Unfortunately, Federal Law No. 323 contains only the analyzed concepts themselves without the criteria “separating” these concepts. In view of this, a number of problems arise, the main of which is the difficulty of determining in practice the presence of a threat to life. As a result, there is an urgent need for a clear description of diseases and pathological conditions, signs indicating a threat to the life of the patient, with the exception of the most obvious (for example, penetrating wounds of the chest, abdominal cavity). It is not clear what the mechanism for determining the threat should be.
Order of the Ministry of Health of Russia dated June 20, 2013 No. 388n “On approval of the Procedure for the provision of emergency, including emergency specialized, medical care” makes it possible to deduce some conditions that indicate a threat to life. The order states that the reason for calling an ambulance in emergency form are sudden acute diseases, conditions, exacerbations of chronic diseases that pose a threat to the life of the patient, including:
- disturbances of consciousness;
- respiratory disorders;
- disorders of the circulatory system;
- mental disorders accompanied by the patient's actions that pose an immediate danger to him or other persons;
- pain syndrome;
- injuries of any etiology, poisoning, wounds (accompanied by life-threatening bleeding or damage to internal organs);
- thermal and chemical burns;
- bleeding of any etiology;
- childbirth, threatened miscarriage.
As you can see, this is only an approximate list, but we believe that it can be used by analogy in the provision of other medical care (not emergency).
However, it follows from the analyzed acts that often the conclusion about the presence of a threat to life is made either by the victim himself or by the ambulance dispatcher, based on the subjective opinion and assessment of what is happening by the person who applied for help. In such a situation, both an overestimation of the danger to life and a clear underestimation of the severity of the patient's condition are possible.
It is to be hoped that the most important details will soon be spelled out in the acts in a more “complete” volume. At the moment, medical organizations probably still should not ignore the medical understanding of the urgency of the situation, the presence of a threat to the life of the patient and the urgency of action. In a medical organization, it is mandatory (or rather, strongly recommendatory) to develop local instructions for emergency medical care on the territory of the organization, which all medical workers should be familiar with.
Article 20 of Law No. 323-FZ states that a necessary precondition for medical intervention is the giving of informed voluntary consent (hereinafter - IDS) of a citizen or his legal representative for medical intervention on the basis of information provided by a healthcare professional in an accessible form complete information about the goals, methods of providing medical care, the risks associated with them, possible options for medical intervention, its consequences, as well as the expected results of the provision of medical care.
However, the situation of medical care in emergency form(which is also considered a medical intervention) is exempt. Namely, medical intervention is allowed without the consent of the person for emergency reasons to eliminate the threat to human life, if the condition does not allow expressing one's will, or there are no legal representatives (paragraph 1 of part 9 of article 20 of the Federal Law No. 323). Similarly, the basis for the disclosure of medical confidentiality without the consent of the patient (paragraph 1 of part 4 of article 13 of the Federal Law No. 323).
In accordance with paragraph 10 of Article 83 of the Federal Law No. 323, the costs associated with the provision of free medical care to citizens in an emergency form by a medical organization, including a medical organization of a private healthcare system, are subject to reimbursement. For reimbursement of expenses for the provision of EMP, read our article: Reimbursement of expenses for the provision of free medical care in an emergency form.
After entry into force Order of the Ministry of Health of Russia dated March 11, 2013 No. 121n“On approval of the Requirements for the organization and performance of work (services) in the provision of primary health care, specialized (including high-tech) ...” (hereinafter - Order of the Ministry of Health No. 121n), many citizens have a well-founded misconception that emergency medical care must be included in the medical license. The type of medical service "emergency medical care", subject, is also indicated in Decree of the Government of the Russian Federation dated April 16, 2012 No. 291"On Licensing Medical Activities".
However, the Ministry of Health of the Russian Federation in its Letter No. 12-3/10/2-5338 dated 07/23/2013 gave the following clarification on this topic: “As for the work (service) in emergency medical care, this work (service) was introduced to license the activities of medical organizations that, in accordance with Part 7 of Article 33 of Federal Law N 323-FZ, created divisions in their structure to provide primary medical care. emergency medical care. In other cases of providing medical care in an emergency form, obtaining a license providing for the performance of works (services) in emergency medical care is not required.
Thus, the type of medical service "emergency medical care" is subject to licensing only by those medical organizations, in the structure of which, in accordance with Article 33 of the Federal Law No. 323, medical care units are created that provide the specified assistance in an emergency form.
The article uses materials from the article Mokhov A.A. Peculiarities of emergency and emergency care in Russia // Legal issues in health care. 2011. No. 9.
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Fainting is a sudden, short-term loss of consciousness due to impaired blood circulation in the brain.
Fainting can last from a few seconds to several minutes. Usually a person comes to his senses after a while. Fainting in itself is not a disease, but rather a symptom of a disease.
Fainting can be due to various reasons:
1. Sudden sharp pain, fear, nervous shocks.
They can cause an instant decrease in blood pressure, resulting in a decrease in blood flow, a violation of the blood supply to the brain, which leads to fainting.
2. General weakness of the body, sometimes aggravated by nervous exhaustion.
General weakness of the body, resulting from the most different reasons ranging from hunger, poor nutrition, to constant worry, can also lead to low blood pressure and fainting.
3. Stay indoors with not enough oxygen.
Oxygen levels can be reduced due to the presence of a large number of people in the room, poor ventilation and air pollution from tobacco smoke. As a result, the brain receives less oxygen than it needs, and the victim faints.
4. Long stay in a standing position without movement.
This leads to stagnation of blood in the legs, a decrease in its flow to the brain and, as a result, to fainting.
Symptoms and signs of fainting:The reaction is a short-term loss of consciousness, the victim falls. In a horizontal position, the blood supply to the brain improves and after a while the victim regains consciousness.
Breathing is rare, superficial. Blood circulation - the pulse is weak and rare.
Other signs are dizziness, tinnitus, severe weakness, veil before the eyes, cold sweat, nausea, numbness of the extremities.
First aid for fainting1. If the airways are free, the victim is breathing and his pulse is felt (weak and rare), he must be laid on his back and his legs raised.
2. Loosen tight clothing, such as collars and waistbands.
3. Put a wet towel on the victim's forehead, or wet his face with cold water. This will lead to vasoconstriction and improve the blood supply to the brain.
4. When vomiting, the victim must be transferred to a safe position, or at least turn his head to the side so that he does not choke on vomit.
5 It must be remembered that fainting can be a manifestation of severe, including acute illness requiring emergency assistance. Therefore, the victim always needs to be examined by his doctor.
6. Do not rush to lift the victim after consciousness has returned to him. If conditions allow, the victim can be given hot tea to drink, and then help to rise and sit down. If the victim again feels faint, he must be laid on his back and raise his legs.
7. If the victim is unconscious for several minutes, most likely it is not fainting and qualified medical assistance is needed.
Shock is a state life threatening the victim and characterized by insufficient blood supply to tissues and internal organs.
The blood supply to tissues and internal organs can be disrupted for two reasons:
Heart problems;
Decrease in the volume of fluid circulating in the body (heavy bleeding, vomiting, diarrhea, etc.).
Symptoms and signs of shock:Reaction - the victim is usually conscious. However, the condition can worsen very quickly, up to loss of consciousness. This is due to a decrease in blood supply to the brain.
The airways are usually free. If there is internal bleeding, there may be a problem.
Breathing - frequent, superficial. Such breathing is explained by the fact that the body is trying to get as much oxygen as possible with a limited amount of blood.
Blood circulation - the pulse is weak and frequent. The heart tries to compensate for the decrease in circulating blood volume by speeding up the circulation. A decrease in blood volume leads to a drop in blood pressure.
Other signs are that the skin is pale, especially around the lips and earlobes, cool and clammy. This is because the blood vessels in the skin close to direct blood to vital organs such as the brain, kidneys, etc. The sweat glands also increase activity. The victim may feel thirsty, due to the fact that the brain feels a lack of fluid. Muscle weakness occurs due to the fact that blood from the muscles goes to the internal organs. There may be nausea, vomiting, chills. Chill means lack of oxygen.
First aid for shock1. If the shock is caused by impaired blood circulation, then first of all you need to take care of the brain - to ensure the supply of oxygen to it. To do this, if damage allows, the victim must be laid on his back, his legs raised and the bleeding stopped as soon as possible.
If the victim has a head injury, then the legs cannot be raised.
The victim must be laid on his back, putting something under his head.
2. If the shock is caused by burns, then first of all it is necessary to ensure the termination of the effect of the damaging factor.
Then cool the affected area of the body, if necessary, lay the victim with raised legs and cover with something to keep warm.
3. If the shock is caused by a violation of cardiac activity, the victim must be given a semi-sitting position, placing pillows or folded clothes under his head and shoulders, as well as under his knees.
Laying the victim on his back is impractical, since in this case it will be more difficult for him to breathe. Have the victim chew an aspirin tablet.
In all of the above cases, it is necessary to call ambulance and prior to her arrival, monitor the condition of the victim, being ready to start cardiopulmonary resuscitation.
When assisting a victim in shock, it is unacceptable:Move the victim, except when necessary;
Give the victim food, drink, smoke;
Leave the victim alone, except in cases where it is necessary to leave to call an ambulance;
Warm the victim with a heating pad or some other source of heat.
ANAPHYLACTIC SHOCK
Anaphylactic shock is a massive allergic reaction immediate type that occurs when an allergen enters the body (insect bites, drug or food allergens).
Anaphylactic shock usually develops within seconds and is an emergency that requires immediate attention.
If anaphylactic shock is accompanied by loss of consciousness, immediate hospitalization is necessary, since the victim in this case may die within 5-30 minutes with asphyxia or after 24-48 hours or more due to severe irreversible changes vital organs.
Sometimes death can occur later due to changes in the kidneys, gastrointestinal tract, heart, brain and other organs.
Symptoms and signs of anaphylactic shock:Reaction - the victim feels anxiety, a feeling of fear, as shock develops, loss of consciousness is possible.
Airways - Swelling of the airways occurs.
Respiration - similar to asthmatic. Shortness of breath, chest tightness, cough, intermittent, difficult, may stop altogether.
Blood circulation - the pulse is weak, rapid, may not be palpable on the radial artery.
Other signs - the chest is tense, swelling of the face and neck, swelling around the eyes, redness of the skin, rash, red spots on the face.
First aid for anaphylactic shock1. If the victim is conscious, give him a semi-sitting position to facilitate breathing. It is better to put him on the floor, unbutton the collar and loosen other pressing parts of the clothing.
2. Call an ambulance.
3. If the victim is unconscious, move him to a safe position, control breathing and blood circulation and be ready to proceed with cardiopulmonary resuscitation.
ATTACK OF BRONCHIAL ASTHMA
Bronchial asthma is an allergic disease, the main manifestation of which is an asthma attack caused by impaired bronchial patency.
An attack of bronchial asthma is caused by various allergens (pollen and other substances of plant and animal origin, industrial products, etc.)
Bronchial asthma is expressed in attacks of suffocation, experienced as a painful lack of air, although in reality it is based on difficulty exhaling. The reason for this is the inflammatory narrowing of the airways caused by allergens.
Symptoms and signs of bronchial asthma:Reaction - the victim may be alarmed, in severe attacks he cannot utter a few words in a row, he may lose consciousness.
Airways - may be narrowed.
Breathing - characterized by obstructed elongated exhalation with many wheezing wheezes, often heard at a distance. Shortness of breath, cough, initially dry, and in the end - with the separation of viscous sputum.
Blood circulation - at first the pulse is normal, then it becomes rapid. At the end of a prolonged attack, the pulse may become thready until the heart stops.
Other signs are anxiety, extreme fatigue, sweating, tension in the chest, talking in a whisper, blue skin, nasolabial triangle.
First aid for an attack of bronchial asthma1. Remove the victim to fresh air, unfasten the collar and loosen the belt. Sit with an inclination forward and with an emphasis on the chest. In this position, the airways open.
2. If the victim has any medications, help them use them.
3. Call an ambulance immediately if:
This is the first attack;
The attack did not stop after taking the medicine;
The victim has too difficult breathing and it is difficult for him to speak;
The victim is showing signs of extreme exhaustion.
HYPERVENTILATION
Hyperventilation - excessive in relation to the level of exchange of pulmonary ventilation, due to deep and (or) rapid breathing and leading to a decrease in carbon dioxide and an increase in oxygen in the blood.
The cause of hyperventilation is most often panic or serious excitement caused by fear or any other reasons.
Feeling great excitement or panic, the person begins to breathe faster, which leads to a sharp decrease in the carbon dioxide content in the blood. Hyperventilation sets in. The victim begins in connection with this to feel even more anxiety, which leads to increased hyperventilation.
Symptoms and signs of hyperventilation:Reaction - the victim is usually alarmed, feels confused. Airways - open, free.
Breathing is naturally deep and frequent. As hyperventilation develops, the victim breathes more and more often, but subjectively feels suffocation.
Blood circulation - does not help to recognize the cause.
Other signs - the victim feels dizzy, sore throat, tingling in the arms, legs or mouth, the heartbeat may increase. Looking for attention, help, can become hysterical, faint.
First aid for hyperventilation.1. Bring a paper bag to the nose and mouth of the victim and ask him to breathe the air that he exhales into this bag. In this case, the victim exhales air saturated with carbon dioxide into the bag, and inhales it again.
Usually after 3-5 minutes, the level of saturation of the blood with carbon dioxide returns to normal. The respiratory center in the brain receives relevant information about this and gives a signal: to breathe more slowly and deeply. Soon the muscles of the respiratory organs relax, and the entire respiratory process returns to normal.
2. If the cause of hyperventilation was emotional arousal, it is necessary to calm the victim, restore his sense of confidence, persuade the victim to sit down and relax calmly.
ANGINA
Angina pectoris (angina pectoris) - an attack of acute pain behind the sternum, due to transient insufficiency of the coronary circulation, acute ischemia myocardium.
The cause of an attack of angina pectoris is insufficient blood supply to the heart muscle, caused by coronary insufficiency due to narrowing of the lumen of the coronary (coronary) artery of the heart with atherosclerosis, vascular spasm, or a combination of these factors.
Angina pectoris can occur due to psycho-emotional stress, which can lead to spasm of pathologically unchanged coronary arteries of the heart.
However, most often, angina pectoris still occurs when the coronary arteries narrow, which can be 50-70% of the lumen of the vessel.
Symptoms and signs of angina pectoris:Reaction - the victim is conscious.
The airways are free.
Breathing - superficial, the victim does not have enough air.
Blood circulation - the pulse is weak and frequent.
Other signs - the main symptom of pain syndrome - its paroxysmal. Pain has a fairly clear beginning and end. By nature, the pain is compressive, pressing, sometimes in the form of a burning sensation. As a rule, it is localized behind the sternum. Characterized by irradiation of pain in the left side of the chest, in left hand to the fingers left shoulder blade and shoulder, neck, lower jaw.
The duration of pain in angina pectoris, as a rule, does not exceed 10-15 minutes. Usually they occur at the time of physical exertion, most often when walking, and also during stress.
First aid for angina pectoris.1. If an attack develops physical activity, you need to stop the load, for example, stop.
2. Give the victim a semi-sitting position, placing pillows or folded clothing under his head and shoulders, as well as under his knees.
3. If the victim has previously had angina attacks, for the relief of which he used nitroglycerin, he can take it. For faster absorption, a nitroglycerin tablet must be placed under the tongue.
The victim should be warned that after taking nitroglycerin, there may be a feeling of fullness in the head and headache, sometimes dizziness, and, if you stand, fainting. Therefore, the victim should remain in a semi-sitting position for some time even after the pain has passed.
In the case of the effectiveness of nitroglycerin, an angina attack disappears after 2-3 minutes.
If after a few minutes after taking the drug the pain has not disappeared, you can take it again.
If, after taking the third pill, the victim’s pain does not go away and drags on for more than 10–20 minutes, it is urgent to call an ambulance, since there is a possibility of developing a heart attack.
HEART ATTACK (MYOCARDIAL INFARCTION)
Heart attack (myocardial infarction) - necrosis (necrosis) of a section of the heart muscle due to a violation of its blood supply, manifested in a violation of cardiac activity.
A heart attack occurs due to blockage of a coronary artery by a thrombus - a blood clot that forms at the site of a narrowing of the vessel during atherosclerosis. As a result, a more or less extensive area of the heart is “turned off”, depending on which part of the myocardium was supplied with blood by the clogged vessel. A thrombus cuts off the supply of oxygen to the heart muscle, resulting in necrosis.
Causes of a heart attack can be:
Atherosclerosis;
Hypertonic disease;
Physical activity in combination with emotional stress - vasospasm during stress;
Diabetes and other metabolic diseases;
genetic predisposition;
Environmental influence, etc.
Symptoms and signs of a heart attack (heart attack):Reaction - in the initial period of a painful attack, restless behavior, often accompanied by a fear of death, in the future, loss of consciousness is possible.
The airways are usually free.
Breathing - frequent, shallow, may stop. In some cases, asthma attacks are observed.
Blood circulation - the pulse is weak, fast, may be intermittent. Possible cardiac arrest.
Other signs are severe pain in the region of the heart, usually occurring suddenly, more often behind the sternum or to the left of it. The nature of the pain is compressive, pressing, burning. Usually it radiates to the left shoulder, arm, shoulder blade. Often with a heart attack, unlike angina pectoris, the pain spreads to the right of the sternum, sometimes captures the epigastric region and "gives" to both shoulder blades. The pain is growing. The duration of a painful attack during a heart attack is calculated in tens of minutes, hours, and sometimes days. There may be nausea and vomiting, the face and lips may turn blue, severe sweating. The victim may lose the ability to speak.
First aid for a heart attack.1. If the victim is conscious, give him a semi-sitting position, placing pillows or folded clothes under his head and shoulders, as well as under his knees.
2. Give the victim an aspirin tablet and ask him to chew it.
3. Loosen the squeezing parts of the clothing, especially at the neck.
4. Immediately call an ambulance.
5. If the victim is unconscious but breathing, put him in a safe position.
6. Control breathing and blood circulation, in case of cardiac arrest, immediately begin cardiopulmonary resuscitation.
Stroke - caused pathological process acute disorder blood circulation in the brain or spinal cord with the development of persistent symptoms of damage to the central nervous system.
The cause of a stroke can be a hemorrhage in the brain, cessation or weakening of the blood supply to any part of the brain, blockage of the vessel by a thrombus or embolus (a thrombus is a dense blood clot in the lumen of a blood vessel or heart cavity, formed in vivo; an embolus is a substrate circulating in the blood, not found in normal conditions and can cause blockage of blood vessels).
Strokes are more common in the elderly, although they can occur at any age. More commonly seen in men than in women. About 50% of those affected by a stroke die. Of those who survive, about 50% become crippled and have another stroke weeks, months, or years later. However, many stroke survivors regain their health through rehabilitation measures.
Symptoms and signs of a stroke:The reaction is confused consciousness, there may be a loss of consciousness.
The airways are free.
Breathing - slow, deep, noisy, wheezing.
Blood circulation - the pulse is rare, strong, with good filling.
Other signs are a severe headache, the face may turn red, become dry, hot, speech disturbances or slowdowns may be observed, the corner of the lips may sag even if the victim is conscious. The pupil on the affected side may be dilated.
With a slight lesion, weakness, with a significant one, complete paralysis.
First aid for stroke1. Call for qualified medical assistance immediately.
2. If the victim is unconscious, check if the airways are open, restore airway patency if it is broken. If the victim is unconscious, but breathing, move him to a safe position on the side of the injury (to the side where the pupil is dilated). In this case, the weakened or paralyzed part of the body will remain at the top.
3. Be prepared for rapid deterioration and CPR.
4. If the victim is conscious, lay him on his back with something under his head.
5. The victim may have a micro-stroke, in which there is a slight speech disorder, slight clouding of consciousness, slight dizziness, muscle weakness.
In this case, when providing first aid, you should try to protect the victim from falling, calm and support him and immediately call an ambulance. Control DP - D - K and be ready to provide emergency assistance.
epileptic seizure
Epilepsy is a chronic disease caused by damage to the brain, manifested by repeated convulsive or other seizures and is accompanied by a variety of personality changes.
An epileptic seizure is caused by excessively intense excitation of the brain, which is due to an imbalance in the human bioelectrical system. Typically, a group of cells in one part of the brain loses electrical stability. This creates a strong electrical discharge that rapidly spreads to the surrounding cells, disrupting their normal functioning.
Electrical phenomena can affect the entire brain or only part of it. Accordingly, there are major and minor epileptic seizures.
A minor epileptic seizure is a short-term disturbance of brain activity, leading to a temporary loss of consciousness.
Symptoms and signs of a small epileptic seizure:The reaction is a temporary loss of consciousness (from a few seconds to a minute). The airways are open.
Breathing is normal.
Blood circulation - pulse normal.
Other signs are an unseeing gaze, repetitive or twitching movements of individual muscles (head, lips, arms, etc.).
A person comes out of such a seizure as suddenly as he enters it, and he continues the interrupted actions, not realizing that a seizure has occurred to him.
First aid for small epileptic fit1. Eliminate the danger, seat the victim and calm him down.
2. When the victim wakes up, tell him about the seizure, as this may be his first seizure and the victim does not know about the disease.
3. If this is your first seizure, see your doctor.
Grand mal seizure is sudden loss consciousness, accompanied by severe convulsions (convulsions) of the body and limbs.
Symptoms and signs of a grand mal seizure:Reaction - begins with sensations close to euphoric (unusual taste, smell, sound), then loss of consciousness.
The airways are free.
Breathing - may stop, but recovers quickly. Blood circulation - pulse normal.
Other signs - usually the victim falls to the floor without consciousness, he begins to have sharp convulsive movements of the head, arms and legs. There may be a loss of control over physiological functions. The tongue is bitten, the face turns pale, then becomes bluish. The pupils do not react to light. Foam may come out of the mouth. The total duration of the seizure ranges from 20 seconds to 2 minutes.
First aid for a major epileptic seizure1. Noticing that someone is on the verge of a seizure, you must try to make sure that the victim does not harm himself when falling.
2. Make room around the victim and put something soft under his head.
3. Loosen clothing around the victim's neck and chest.
4. Do not try to restrain the victim. If his teeth are clenched, do not try to open his jaws. Do not try to put something in the victim's mouth, as this can lead to trauma to the teeth and block the airways with their fragments.
5. After the cessation of convulsions, transfer the victim to a safe position.
6. Treat all injuries sustained by the victim during the seizure.
7. After the seizure has stopped, the victim must be hospitalized if:
The attack happened for the first time;
There was a series of seizures;
There are damages;
The victim was unconscious for more than 10 minutes.
HYPOGLYCEMIA
Hypoglycemia - low blood glucose Hypoglycemia can occur in a diabetic patient.
Diabetes is a disease in which the body does not produce enough of the hormone insulin, which regulates the amount of sugar in the blood.
If the brain does not receive enough sugar, then, just as with a lack of oxygen, brain functions are impaired.
Hypoglycemia can occur in a diabetic patient for three reasons:
1) the victim injected insulin, but did not eat on time;
2) with excessive or prolonged physical activity;
3) with an overdose of insulin.
Symptoms and signs of hypoglycemia:The reaction is confused consciousness, loss of consciousness is possible.
Respiratory tract - clean, free. Breathing - rapid, superficial. Blood circulation - a rare pulse.
Other signs are weakness, drowsiness, dizziness. Feeling of hunger, fear, pallor of the skin, profuse sweat. Visual and auditory hallucinations, muscle tension, trembling, convulsions.
First aid for hypoglycemia1. If the victim is conscious, give him a relaxed position (lying or sitting).
2. Give the victim a sugar drink (two tablespoons of sugar in a glass of water), a sugar cube, chocolate or sweets, you can caramel or cookies. The sweetener doesn't help.
3. Provide rest until the condition is completely normal.
4. If the victim has lost consciousness, transfer him to a safe position, call an ambulance and monitor the condition, be ready to proceed with cardiopulmonary resuscitation.
POISONING
Poisoning - intoxication of the body caused by the action of substances entering it from the outside.
Poisonous substances can enter the body in a different way. There are different classifications of poisoning. So, for example, poisoning can be classified according to the conditions for the entry of toxic substances into the body:
During a meal;
Through the respiratory tract;
through the skin;
When bitten by an animal, insect, snake, etc.;
through mucous membranes.
Poisoning can be classified according to the type of poisoning:
food poisoning;
medicinal poisoning;
Alcohol poisoning;
poisoning chemicals;
gas poisoning;
Poisoning caused by bites of insects, snakes, animals.
The task of first aid is to prevent further exposure to the poison, to accelerate its removal from the body, to neutralize the remains of the poison and to support the activity of the affected organs and body systems.
To solve this problem, you need:1. Take care of yourself so as not to get poisoned, otherwise you will need help yourself, and the victim will have no one to help.
2. Check the reaction, respiratory tract, breathing and blood circulation of the victim, if necessary, take appropriate measures.
5. Call an ambulance.
4. If possible, set the type of poison. If the victim is conscious, ask him about what happened. If unconscious - try to find witnesses of the incident, or packaging from toxic substances or some other signs.
