home All hormones Emergency conditions in children in dow. Emergency conditions in children. Rules and principles of first aid for clinical signs of these conditions, nursing measures and criteria for assessing their practical effectiveness. Baby and Carlson

Emergency conditions in children in dow. Emergency conditions in children. Rules and principles of first aid for clinical signs of these conditions, nursing measures and criteria for assessing their practical effectiveness. Baby and Carlson

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On the topic: “Emergencies in pediatrics. First aid for children and childbirth outside the hospital"

Completed by: 1st year student, group 15

Bolotskikh Yu.

Plan

1. First aid for children. Emergency conditions in pediatrics

1.1 Anaphylactic shock

1.2 Hyperthermia

1.3 Diarrhea

1.4 Collapse

1.5 Laryngospasm

1.6 Flatulence

1.7 Stenosing laryngitis (“false croup”)

1.8 Seizures

1.9 Fainting

1.10 Acute poisoning in children

1.12 Nosebleed

1.13 Airway obstruction

2. Childbirth outside the hospital

Bibliography

1. First aid for children.Nemergency conditions in pediatrics

Every person must have thorough knowledge and skills regarding the provision of emergency pre-hospital medical care to a child in critical conditions, serious illnesses and accidents.

In children, the rapid development of life-threatening conditions is due to many factors, which include the anatomical and physiological characteristics of the child’s body, imperfect regulation of the functioning of its systems, and the presence of background diseases. After emergency care has been provided at the pre-hospital stage, without which the life of the sick child remains at risk, further treatment of the patient can be continued in the hospital.

Pediatric emergencies include:

· Anaphylactic shock

· Hyperthermia

· Collapse

· Laryngospasm

Flatulence

Stenosing laryngitis (“false croup”)

· Convulsions.

· Fainting

Acute poisoning in children

· Nose bleed.

· Obstruction of the respiratory tract.

Due to the anatomical and physiological characteristics of organs and systems, emergency conditions in children are characterized by a rapid, progressive course, often with an atypical clinical picture, which makes it difficult to correctly interpret symptoms. Most acute diseases in children require decisive, immediate action, both in terms of diagnosis and the choice of treatment tactics. It is the qualified actions of the doctor in emergency situations that are often decisive for their outcome.

1.1 Anaphylactic shock

This is a severe allergic reaction that develops rapidly (from a few minutes to 4 hours) after exposure to the allergen.

Causes: allergens may include antibiotics, especially penicillin, aspirin, novocaine, B vitamins, food products, stinging insect venom.

Clinic: manifested by loss of consciousness, shortness of breath, difficulty breathing, cyanosis (blueness) of the skin and cold sweat, blood pressure drops, palpitations occur, convulsions are observed, respiratory failure develops, including respiratory arrest.

First aid: At the first sign of shock, you should call for help. Before the ambulance arrives:

· immediately stop further entry of the allergen into the body, block its absorption. If the cause was an injection, apply a tourniquet above the injection site. If the cause is an insect bite (bee, wasp), remove the sting with tweezers. Apply ice to the bite site. If the allergen is administered orally, rinse the stomach.

· Place the child on his back with his head down and legs raised;

To prevent aspiration of vomit, turn your head to the side;

· unbutton tight clothing;

· warm the child (cover with a blanket);

· give a tablet of suprastin or tavegil.

1.2 Hyperthermia

This increase in body temperature above 37 0 C is the most common symptom of the disease in children.

Hyperthermia (fever) is a protective-compensatory reaction, due to which the body’s immune response to the disease is enhanced, as well as a symptom indicating the presence of a pathological process in the body. However, it must be remembered that, like most nonspecific protective reactions (pain, inflammation, shock), fever plays its protective adaptive role only to certain limits. With a progressive increase in temperature, there is a significant increase in the load on breathing and blood circulation (for every degree of temperature increase above 37°C, the respiratory rate increases by 4 breaths per minute, the pulse by 10 beats per minute), which leads to an increase in the supply of oxygen to the blood. But the increased amount of oxygen in the blood no longer provides the increasing tissue needs for it, hypoxia develops, from which the central nervous system primarily suffers and often develops febrile seizures. Most often, they are observed against a background of a temperature of 39-40°C, although the degree of hyperthermia at which these disorders occur is very variable and depends on the individual characteristics of the child’s body.

Types of hyperthermia

Causes: infection (viral bacterial), toxic, organic brain damage, etc.

First aid:

· Put the child to bed.

· Give plenty of fluids.

· At a temperature of 38.5°C and above, carry out physical cooling (remove clothes, rub the skin with a sponge moistened with water at room temperature, along large vessels). Do not use alcohol or alcohol-containing preparations. Give antipyretics (paracetamol, ibuprofen) at the rate of 10-15 mg/kg body weight. Aspirin and cefecone suppositories are not recommended for children to lower their temperature. up to 12 years

· After 20-30 minutes. repeat thermometry. If your condition is serious, call an ambulance.

1.3 Diarrhea

This is loose, watery stool. ( three or more times a day). Diarrhea can lead to dehydration and even death.

Causes. Diarrhea is common in young children who are fed cow's milk or formula.

Clinic. The stool is watery, sometimes with particles of undigested food, with an unpleasant odor, and may be green in color. If there is blood in the child's stool, it is dysentery. If the child is lethargic, lethargic or unconscious, has sunken eyes, cannot drink or drinks poorly, when taking a skin fold in the side of the abdomen it straightens out very slowly (more than 2 seconds), then the child is severely dehydrated and needs immediate hospitalization.

First aid.

· See a doctor immediately.

· Avoid dehydration, to do this, continue breastfeeding, if the child is breastfeeding, give the child liquids (water, compote), liquid food (for example, soup, rice water, yogurt-based drinks);

· you can prepare an ORS solution (sold in a pharmacy without a prescription) and give the child as much water as he wants.

1.4 Collapse

This is a severe form of acute vascular insufficiency.

Causes: Collapse is the result of significant blood loss or redistribution of blood in the vascular bed (most of the blood accumulates in the peripheral vessels and abdominal organs), resulting in a sharp drop in blood pressure.

Clinic:

Sudden deterioration of condition;

Paleness of the skin;

Cold clammy sweat;

Frequent thready pulse;

Low blood pressure.

First aid:

Call an ambulance.

Before the ambulance arrives:

· Place the child on a hard surface with the head down.

· Unbutton tight clothing.

· Provide access to fresh air.

1.5 Laryngospasm

Causes: most often occurs when a child is crying, screaming, or scared. Laryngospasm is one of the forms of obvious spasmophilia - a disease of children mainly of young age, characterized by a tendency to convulsions and increased neuromuscular excitability due to a decrease in the level of calcium in the body. Spasmophilia is always associated with rickets.

Clinic: manifests itself with a sonorous or hoarse breath and stopping breathing for a few seconds: at this moment the child first turns pale, then he develops cyanosis, he loses consciousness. The attack ends with a deep, sonorous “crow of a cock” breath, after which the child almost always cries, but after a few minutes he returns to normal and often falls asleep. In the most severe cases, death may result from sudden cardiac arrest.

Firsthelp:

· Place the child on a flat, hard surface.

· Unbutton tight clothing.

· Provide access to fresh air.

· Create a calm environment.

· Sprinkle the child's face and body with cold water, or cause irritation of the nasal mucosa (tickle with a cotton swab, blow into the nose, bring ammonia, or with a spatula, press on the root of the tongue with a spoon).

· In case of cardiac arrest, perform indirect cardiac massage.

1.6 Flatulence

This is bloating due to gases accumulated in the intestines.

Clinic: the child is crying, worried, the tummy is swollen, rumbling can be heard.

First aid:

· Lay the child on his back, free the lower half of the body.

· Provide access to fresh air.

· Perform a light abdominal massage in a clockwise direction.

· If there is no effect from previous measures, install a gas outlet tube.

· If there is no effect, give carbolene (activated carbon) or smecta.

· Eliminate gas-forming foods from the diet: fresh milk, carbonated drinks, vegetables, legumes, black bread.

1.7 Stenosing laryngitis(“false croup”)

This is an acute disease characterized by obstruction of the airways in the larynx and the development of respiratory failure.

Causes: develops due to stenosis in the glottis area, swelling of the subglottic space, accumulation of sputum in the lumen of the larynx.

Kleeneka:

Rough "barking" cough;

Phenomena of respiratory failure (the child is restless, tosses around in bed, shortness of breath, difficulty breathing, cyanosis appear, auxiliary muscles are involved in the act of breathing: wings of the nose, intercostal muscles, diaphragm, etc.).

Firsthelp:

· Place the child with the head end elevated.

· Unbutton tight clothing.

· Provide access to fresh air

Create a calm environment

· Carry out distraction therapy (put mustard plasters on the calf muscles or conduct mustard foot baths).

· Carry out steam inhalations with the addition of soda and expectorant herbs (alternating them)

1.8 Convulsions

This is an involuntary muscle contraction that causes distortion of the shape of the body and limbs.

Causes: Febrile seizures occur with high fever in infants and young children. Afebrile seizures in infants most often result from birth trauma or brain damage. Rhythmic spasms of the limbs are characteristic symptoms of epilepsy.

Clinic. Cramps can be local (spread to individual muscle groups) and generalized (convulsive seizure).

Phases of a seizure

First aid

· Call an ambulance.

· Place the child on a flat, soft surface and remove any possible damaging objects.

· Unbutton tight clothing.

· Provide access to fresh air.

· Do not leave the child alone until the ambulance arrives.

1.9 Fainting

This is a manifestation of vascular insufficiency, which is accompanied by cerebral ischemia and is manifested by a short-term loss of consciousness.

First aid

· Call an ambulance.

· Place the child on a flat surface with his legs raised (or sit him down and sharply tilt his head down)

· Unbutton tight clothing

· Provide access to fresh air

· Spray the child’s face and body with cold water or give ammonia (acetic acid) a sniff.

1.10 Acute poisoning in children

This is a pathological process accompanied by a violation of the physiological functions of the body due to the ingress of one or more toxic substances from the environment. In most cases, acute poisoning occurs at home. They are associated with improper storage of medications and drug overdose. Poisoning with household chemicals, poisonous plants, and mushrooms is common; cases of substance abuse and suicidal poisoning are possible. Poisoning in children occurs mainly when poison is ingested. The entrance gates for toxic substances can be the skin, mucous membranes and respiratory tract.

Clinic. In childhood, acute poisoning is more severe than in adults. This is due to greater permeability of the skin, mucous membranes and blood-brain barrier, pronounced lability of water-electrolyte metabolism. Most poisons are absorbed within the first hour after administration, sometimes this process drags on for up to several days (for example, in case of poisoning with sleeping pills).

First aid.

· Call an ambulance.

· Before the ambulance arrives, try to find out what caused the poisoning.

· Any suspicion of acute poisoning is an indication for hospitalization of the child, regardless of the severity of his condition.

· If poison gets on your skin, rinse it immediately without rubbing with plenty of warm running water.

· If toxic substances come into contact with the eyes, the latter are washed copiously and for 10-20 minutes. water (preferably boiled) or saline, instill a local anesthetic (0.5 solution of novocaine, dicaine).

· If the child is conscious, in contact and has just swallowed poison (tablets, mushrooms, berries, roots, plant leaves, etc.), it is necessary to immediately induce vomiting by reflex irritation of the root of the tongue. Contraindications to reflex vomiting are coma, convulsions, a sharp weakening of the gag reflex, poisoning with acids and caustic alkalis, gasoline, kerosene, turpentine, phenol.

· Rinse the stomach. Do not rinse if poisoning occurs in late periods (after 2 hours) after poisoning with alkalis and corrosive poisons due to the high risk of perforation of the esophagus and stomach; convulsive syndrome due to possible aspiration of gastric contents.

· To remove poison from the intestines, give a cleansing enema.

· Give up to 10 tablets of activated carbon.

1.11 Vomit

Causes the appearance of vomiting: poisoning; intoxication; diseases of the gastrointestinal tract; diseases of the central nervous system.

First aid

· Provide access to fresh air (make breathing easier, eliminate unpleasant odors).

· Lay the child down with the head end elevated, head turned to the side (to prevent aspiration of vomit).

· Unbutton tight clothing.

· After vomiting, rinse your mouth with boiled water.

· Contact a healthcare professional as soon as possible.

1.12 Nose bleed

Causes. Nosebleeds can appear after an injury or be a sign of diseases: vitamin deficiency, liver, kidney, blood diseases, high blood pressure, endocrine disorders in girls.

Clinic. Based on location, nosebleeds are divided into anterior and posterior. Damage to the anterior sections of the nose is accompanied by blood leaking out; if the posterior sections are damaged, ingestion of blood can stimulate gastric or pulmonary bleeding. In cases of heavy bleeding, pallor, lethargy, dizziness, and tinnitus appear.

Firsthelp.

· Calm and sit the child down.

· Unbutton tight clothing.

· Suggest breathing deeply and evenly.

· In order to prevent blood from flowing into the oral cavity or pharynx, tilt your head forward and press the wing of your nose against the septum.

· A cotton swab moistened with a 3% solution of hydrogen peroxide can be inserted into the vestibule of the nose.

· If there is no effect, call an ambulance or take the child to the hospital.

emergency pediatrics hyperthermia syncope

1.13 Airway obstruction

Causes. Entry of objects into the respiratory tract during a sharp inhalation with a stream of air. The lumen of the trachea in a child of different ages is 0.5 - 1 - 1.5 cm. Therefore, almost any object can cause complete blockage (obstruction) of the trachea. Respiratory failure causes loss of consciousness very quickly and then circulatory arrest.

Clinic. In case of partial obstruction of the respiratory tract, a hoarse voice and cough suddenly appear. The child becomes restless and clutches his throat with his hands. Breathing is noisy, wheezing. With complete obstruction, the child cannot speak, cough, breathe, and grabs his throat with his hands. With complete airway obstruction, children cannot cry. Upon examination, blue discoloration appears on the lips, face, neck, and hands. Young children may not have the characteristic sign of obstruction (grabbing the neck).

First aid.

· Call an ambulance.

· If a child has signs of complete obstruction of the respiratory tract (does not breathe, does not cough, does not speak) and he is conscious, a series of blows to the back must be applied.

To do this, stand on the side and slightly behind the child;

Support his chest with one hand and tilt the child forward so that the foreign body can come out of the mouth;

Apply up to five sharp blows between the shoulder blades with the heel of the palm of the other hand.

· If five blows to the back do not relieve the obstruction, give five thrusts to the abdomen as follows:

Stand behind the victim and place both hands around his upper abdomen;

Tilt the victim forward;

Make a fist and place it between the navel and sternum;

Grab this hand with your other hand and sharply pull inward and upward;

Repeat up to five times.

· Alternate pressure on the stomach and blows between the shoulder blades until the airways are cleared.

If the airways are blocked in children under two to three years of age:

· Place the child on your arm, face down on your palm, so that the legs are located on opposite sides of your forearm and the axis of the body is tilted down. Use your hip to support the baby.

· Apply pats with the palm of your hand or several fingers between the shoulder blades until the airways are cleared.

2. Childbirth outside the hospital

Childbirth is the physiological process of expulsion of the fetus, membranes and placenta through the mother's birth canal. Childbirth outside the hospital most often occurs during premature pregnancy (from 22 to 37 weeks of pregnancy) or during full-term pregnancy in multiparous women. In such cases, they usually proceed rapidly.

During childbirth, there are 3 periods. Labor develops with precursors: irregular pain appears in the lower abdomen, mucus leaves.

In the first period, regular contractions occur (rhythmic contractions of the muscles of the uterus), pain of varying intensity appears, the uterus becomes dense and tense. The onset of labor is considered to be 4 contractions in 20 minutes or 8 contractions in 60 minutes. In preterm labor and childbirth in multiparous women, contractions are intense from the very beginning. As labor progresses well, the woman in labor loses amniotic fluid, which usually indicates sufficient or complete dilatation of the cervix. Towards the end of the first stage of labor, contractions become more frequent and stronger.

Then the second stage of labor begins, the woman in labor begins to push, and the baby is born.

Soon the afterbirth is born - this is the third stage of labor.

First aid.

· Call an ambulance.

· Help the woman in labor take a comfortable position (on her side or half-lying, half-sitting, leaning her back against a wall, a high headboard, a car seat, a bundle of blankets).

· Free the woman in labor from clothing below the waist; place the cleanest cloth or piece of clothing under it.

· Cover the woman in labor with a blanket or the warmest and cleanest items of clothing.

· Prepare:

Boiling water, boiled or clean water,

A weak (pale pink) solution of potassium permanganate - 3-4 crystals per 1 liter of water (it is advisable to strain this solution through gauze so that the remaining crystals do not injure the skin);

Alcohol or alcohol-containing liquid (vodka, cologne, eau de toilette); brilliant green, alcohol solution of iodine;

Sharp, clean scissors, immersed in boiling water for several minutes and then thoroughly wiped with alcohol (in the field, scissors can be replaced with a knife treated with an alcohol solution of iodine or alcohol);

Bandages and cotton wool;

Two strong threads about 20 cm long, dipped in alcohol (bandages can be used instead);

A small boiled syringe (“pear”), you can replace it with a pipette with a blunt end or a clean thin cocktail tube);

Disposable wipes;

Clean oilcloth or plastic film wiped with alcohol;

Clean diapers, sheets, pillowcases, pieces of fabric, clothes, etc.

· During contractions, massage the back in the area of the sacrum, the inner surface of the thighs, the protrusions of the pelvic bones in the right and left iliac region - these techniques distract and help to endure pain more easily.

· Monitor your breathing; During a contraction, you should breathe shallowly with your mouth wide open, and breathe normally between contractions.

· Don’t forget to wet the woman’s face and give her mouth to rinse.

· As soon as the desire to push appears, the woman should be laid on her back and her legs spread apart.

· Wash your hands thoroughly with soap and treat with alcohol or iodine.

· Wash the woman in labor strictly from front to back - first with water, then with a weak solution of potassium permanganate and treat the perineum and inner thighs with iodine.

· The expansion of the opening of the rectum and the tension of the perineum during contractions allows us to judge that the baby’s head has dropped to the pelvic floor.

· During each attempt, ask the woman to breathe frequently and shallowly - “like a dog.”

· As soon as the baby's head is born, carefully pick it up with your left hand, and with your right hand begin to remove mucus from the nose and mouth. To do this, you can wipe the baby's face with a clean napkin, or suck out the mucus with a pear. In the absence of a syringe, you can use a blunt pipette or tube.

· Support the baby with your hands while the shoulders and the whole body are born. If there is an umbilical cord loop around the baby's neck, remove it through the head without waiting for the whole body to be born. When the baby is born whole, take him in your palm so that he lies tummy down, and his head is located slightly below the body (upside down). For the child to start breathing, massage his chest and back with your finger; You can lightly pat the back and soles of your feet.

· The umbilical cord should be cut 1-2 minutes after the baby is born. To do this, it is necessary, stepping back from the child’s umbilical ring at least 10 cm, to tightly tie the umbilical cord with alcohol-based threads or a sterile bandage in two places at a distance of 3 cm and cross it in the middle with scissors. It is better to treat the cut end of the umbilical cord connecting to the baby with an alcohol solution of iodine and wrap it in a sterile bandage.

· 5-20 minutes after the birth of the baby, the placenta should separate; You cannot speed up the process by pulling on the umbilical cord: it may break, which often causes bleeding.

· Dry the baby with a blotting motion and wrap it in a warm, clean cloth. make sure it doesn't get too cold.

· Collect the birth placenta in a plastic bag and deliver it to the maternity hospital along with the mother and the newborn.

Spsearch for literature used

1. WHO Pocket Guide “Providing hospital care for children”, WHO. 2nd edition. Publisher: Europe "WHO", 2005. (pp. 11-89)

2. ETAT. Emergency assessment for triage and treatment. WHO, 2012. 4th edition. Moscow: SpetsLit. (pp. 105-167)

3. Clinical protocols in neonatology. 1st edition. Bishkek: “Academy”, 2010. (pp. 43-86, 112-157)

4. Solving the problems of newborns: a guide for doctors, nurses, midwives. 1st edition. WHO, 2005 (pp. 8-115)

5. Ezhova N.V., Rusakova E.M., Rovina S.N., Pediatrics. Preclinical practice. 3rd edition. Minsk: Book House, 2004 (pp. 95-167)

6. Petrushina A.D., Malchenko L.A. Emergency conditions in children. 2nd edition. Minsk: “Medical Book”, 2001 (pp. 15-135)

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Pdf-img/38539692_133631651.pdf-9.jpg" alt="> Classification of fever Subfebrile (up to 37.9 *C) Febrile (38.0"> Классификация лихорадки Субфебрильная (до 37, 9 *С) Фебрильная (38, 0 -39, 0 *С) Гипертермическая (39, 1*С и выше)!}

Pdf-img/38539692_133631651.pdf-10.jpg" alt=">Clinical variants of fever “Red” (“pink”) fever “White” ("> Клинические варианты лихорадки «Красная» («розовая») лихорадка «Белая» («бледная») лихорадка!}

Pdf-img/38539692_133631651.pdf-11.jpg" alt="> Emergency care for “pink” fever Paracetamol 10 -15 mg/kg (up to"> Неотложная помощь при «розовой» лихорадке Парацетамол 10 -15 мг/кг (до 60 мг/мг/сут) внутрь или ректально Ибупрофен 5 -10 мг/кг Физические методы охлаждения При неэффективности – в/м литическая смесь (анальгин+супрастин) При неэффективности – см. «бледная» лихорадка!}

Pdf-img/38539692_133631651.pdf-12.jpg" alt="> Emergency care for “pale” fever IM lytic mixture: ü"> Неотложная помощь при «бледной» лихорадке в/м литическая смесь: ü 50% р-р метамизола натрия (анальгин) 0, 1 мл/год üР-р хлорпирамина (Супрастин) 0, 1 мл/год üР-р дротаверина (Но-шпа) 0, 1 мл/год!}

Pdf-img/38539692_133631651.pdf-13.jpg" alt="> Assessment of the effectiveness of antipyretic therapy For “pink” fever - a decrease in t by"> Оценка эффективности антипиретической терапии При «розовой» лихорадке – снижение t на 0, 5* за 30 минут При «бледной» лихорадке – переход в «розовую» и снижение t на 0, 5* за 30 минут!}

Pdf-img/38539692_133631651.pdf-14.jpg" alt="> Indications for emergency hospitalization Ineffective use of two or more regimens"> Показания к экстренной госпитализации Неэффективное использование двух и более схем терапии Неэффективное применение стартовой терапии при «бледной» лихорадке у детей первого года жизни Сочетание устойчивой лихорадки с прогностически неблагоприятными факторами риска!}

Pdf-img/38539692_133631651.pdf-15.jpg" alt="> Task 2. A 4-year-old child suddenly"> Задача 2. У ребенка 4 лет внезапно тошнота, рвота, боли в животе. Со слов матери за час до этого ребенок случайно выпил жидкость для мытья посуды. При осмотре: состояние тяжелое, возбужден, температура нормальная, кожные покровы бледные, тахикардия до 120 в минуту, АД повышено до 115/80 мм. рт. ст. , живот мягкий, болезненный в эпигастрии. 1. Как следует расценить развившееся состояние?!}

Pdf-img/38539692_133631651.pdf-16.jpg" alt=">Acute exogenous poisoning">!}

Pdf-img/38539692_133631651.pdf-17.jpg" alt="> Task 2. A 4-year-old child suddenly"> Задача 2. У ребенка 4 лет внезапно тошнота, рвота, боли в животе. Со слов матери за час до этого ребенок случайно выпил жидкость для мытья посуды. При осмотре: состояние тяжелое, возбужден, температура нормальная, кожные покровы бледные, тахикардия до 120 в минуту, АД повышено до 115/80 мм. рт. ст. , живот мягкий, болезненный в эпигастрии. 2. Какие неотложные мероприятия следует провести?!}

Pdf-img/38539692_133631651.pdf-18.jpg" alt="> keep the child in a supine position without a pillow if vomiting occurs"> удерживать ребенка в положении на спине без подушки, при возникновении рвоты - удерживать голову в боковом положении настойчиво предлагать выпить жидкость (воду, молоко, чай, сок) в привычном количестве, после каждого эпизода рвоты - повторный прием жидкости дать выпить растворенный в воде активированный уголь (1 таблетку на год жизни) госпитализация в токсикологическое отделение!}

Pdf-img/38539692_133631651.pdf-19.jpg" alt="> Task 2. A 4-year-old child suddenly"> Задача 2. У ребенка 4 лет внезапно тошнота, рвота, боли в животе. Со слов матери за час до этого ребенок случайно выпил жидкость для мытья посуды. При осмотре: состояние тяжелое, возбужден, температура нормальная, кожные покровы бледные, тахикардия до 120 в минуту, АД повышено до 115/80 мм. рт. ст. , живот мягкий, болезненный в эпигастрии. 3. Какова тактика дальнейшего лечения?!}

Pdf-img/38539692_133631651.pdf-20.jpg" alt="> Removing poison that has not entered the bloodstream from the stomach (inducing vomiting or"> Удаление яда, не поступившего в кровь из желудка (вызывание рвоты или промывание желудка), из кишечника (назначение слабительных средств, очистительная или сифонная клизма) Удаление яда, поступившего в кровь - форсированный диурез, экстракорпоральная детоксикация, перитонеальный диализ, заменное переливание крови. Антидотная терапия Посиндромная терапия!}

Pdf-img/38539692_133631651.pdf-21.jpg" alt="> Clinic of acute exogenous poisoning Latent period Toxigenic (resorptive) period"> Клиника острых экзогенных отравлений Латентный период Токсигенный (резорбтивный) период Соматогенный период (период поздних осложнений) Восстановительный период!}

Pdf-img/38539692_133631651.pdf-22.jpg" alt=">Emergency care for acute poisoning 1. Removal of the victim from the lesion"> Неотложная помощь при острых отравлениях 1. Удаление пострадавшего из очага поражения 2. Удаление невсосавшегося яда (с кожи, слизистых, из ЖКТ) 3. Удаление всосавшегося яда 4. Антидотная терапия 5. Симптоматическая терапия!}

Pdf-img/38539692_133631651.pdf-23.jpg" alt="> Removing poison from the gastrointestinal tract Inducing vomiting contraindications: üUnconscious state"> Удаления яда из ЖКТ Вызов рвоты противопоказания: üБессознательное состояние ребенка üПри проглатывании сильных кислот, щелочей, растворителей и др. повреждающих СО, пенящихся жидкостей Энтеросорбенты (уголь, полифепам и др.) Зондовое промывание желудка противопоказания üСудорожный синдром, декомпенсация кровообращения и дыхания üОтравление прижигающими средствами, если прошло более 2 часов üОтравление барбитуратами спустя 12 часов Очистительная клизма при находении яда в организме более 2 х часов!}

Pdf-img/38539692_133631651.pdf-24.jpg" alt="> ACUTE POISONING 1. Put the child to bed. 2."> ОСТРЫЕ ОТРАВЛЕНИЯ 1. Уложить ребенка в постель. 2. Если отмечаются явления угнетения или возбуждения ЦНС, потеря сознания, то детей старшего возраста фиксируют, а детей грудного и ясельного возраста пеленают. 3. Во избежание аспирации голову ребенка повернуть на бок. 4. Очистить полость рта от пищевых масс. 5. Наблюдение за больным должно быть постоянным. 6. При отравлении через рот детям старшего возраста, находящимся в сознании, контактным, дают выпить 1- 1, 5 стакана теплой питьевой воды с последующим вызыванием рвоты. Эту процедуру повторяют 3- 4 раза. Последнюю порцию воды дают с активированным углем (5 таблеток) и рвоту не вызывают. Детям младшего возраста (при сохранении акта глотания) для уменьшения концентрации токсического вещества в желудке дают питьевую воду с активированным углем (3 таблетки). 7. При попадании яда на кожу тело ребенка следует обмыть теплой водой. 8. При попадании токсического вещества на слизистую оболочку глаз их необходимо как можно быстрее промыть питьевой водой. Нельзя вызывать рвоту: у детей в сопоре и коме при отравлении кислотами или щелочами!}

Pdf-img/38539692_133631651.pdf-25.jpg" alt="> Task 3. During school, the child"> Задача 3. Во время занятий в школе ребенок 12 лет потерял сознание. Со слов одноклассников жаловался на головную боль и сонливость. При осмотре: отдергивает конечность и открывает глаза в ответ на боль, произносит нечленораздельные звуки. При осмотре отмечается сухость кожных покровов и запах ацетона изо рта. Школьный врач диагностировал гипергликемическую кому. 1. Какую оценку имеет уровень сознания ребенка по шкале Глазго?!}

Pdf-img/38539692_133631651.pdf-26.jpg" alt="> Criterion Points Motor reaction:"> Критерий Баллы Двигательная реакция: Выполняет инструкции 6 Защищает рукой область болевого раздражения 5 Отдергивает конечность в ответ на боль 4 Декортикационная ригидность (сгибание и приведение рук и 3 разгибание ног) Децеребрационная ригидность (разгибание, приведение и 2 внутренняя ротация рук и разгибание ног) Движения отсутствуют 1 Вербальная реакция: Участвует в беседе, речь нормальная; ориентация не нарушена 5 Участвует в беседе, но речь спутанная 4 Бессвязные слова 3 Нечленораздельные звуки 2 Реакция отсутствует 1 Открывание глаз: Спонтанное 4 На речь 3 На боль 2 Не открывает глаза 1 Сумма 8 из 15!}

Pdf-img/38539692_133631651.pdf-27.jpg" alt="> Task 3. During school"> Задача 3. Во время занятий в школе ребенок 12 лет потерял сознание. Со слов одноклассников жаловался на головную боль и сонливость. При осмотре: отдергивает конечность и открывает глаза в ответ на боль, произносит нечленораздельные звуки. При осмотре отчается сухость кожных покровов и запах ацетона изо рта. Школьный врач диагностировал гипергликемическую кому. 2. Какие неотложные мероприятия следует провести?!}

Pdf-img/38539692_133631651.pdf-28.jpg" alt="> restoration of free airway patency and prevention of aspiration of vomit"> восстановление свободной проходимости дыхательных путей и предупреждение аспирации рвотных масс обеспечение положения пациента, предупреждающего травматизацию при судорогах контроль жизненно важных показателей – пульса, дыхания, артериального давления при необходимости – проведение сердечно- легочной реанимации госпитализация в эндокринологическое отделение!}

Pdf-img/38539692_133631651.pdf-29.jpg" alt="> Task 4. A 1.5 year old child fell ill with an acute"> Задача 4. Ребенок 1, 5 лет заболел острой респираторной инфекцией два дня назад. На фоне подъема температуры тела до 39, 8 С возникли кратковременные клонико-тонические судороги. В анамнезе – перинатальное поражение ЦНС. 1. Как следует расценить развившееся состояние?!}

Pdf-img/38539692_133631651.pdf-30.jpg" alt=">Febrile convulsions due to infectious fever.">!}

Pdf-img/38539692_133631651.pdf-31.jpg" alt="> Task 4. A 1.5 year old child fell ill with an acute"> Задача 4. Ребенок 1, 5 лет заболел острой респираторной инфекцией два дня назад. На фоне подъема температуры тела до 39, 8 С возникли кратковременные клонико-тонические судороги. В анамнезе – перинатальное поражение ЦНС. 2. Какие неотложные мероприятия следует провести?!}

Pdf-img/38539692_133631651.pdf-32.jpg" alt="> ensuring airway patency and preventing tongue retraction prevention of injury"> обеспечения проходимости дыхательных путей и предупреждение западения языка профилактика травматизации освободить от тесной одежды, затрудняющей дыхание и обеспечить ему доступ свежего воздуха в/м введение диазепама 0, 05 мл/кг (0, 3 мг/кг) снижение температуры госпитализация в инфекционный стационар!}

Pdf-img/38539692_133631651.pdf-33.jpg" alt="> Task 5. A 2-year-old child fell ill acutely 24 hours"> Задача 5. Ребенок 2 лет заболел остро сутки назад: отмечалась повторная рвота, затем обильный жидкий стул 8 раз, лихорадка до 37, 7 С. При осмотре: кожные покровы и слизистые оболочки сухие, отмечаются акроцианоз, замедление расправления кожной складки до 2 секунд, Со слов матери объем мочи меньше обычного. Масса тела снижена на 8%. 1. Какая степень дегидратации у ребенка?!}

Pdf-img/38539692_133631651.pdf-34.jpg" alt="> I degree - loss of 4–5% of body weight (mild severity)"> I степень - потеря 4– 5% массы тела (лёгкая степень тяжести) II степень - потеря 6– 9% массы тела (средняя степень тяжести) III степень - потеря более 9% массы тела (тяжёлая степень)!}

Pdf-img/38539692_133631651.pdf-35.jpg" alt="> Task 5. A 2-year-old child fell ill acutely 24 hours"> Задача 5. Ребенок 2 лет заболел остро сутки назад: отмечалась повторная рвота, затем обильный жидкий стул 8 раз, лихорадка до 37, 7 С. При осмотре: кожные покровы и слизистые оболочки сухие, отмечаются акроцианоз, замедление расправления кожной складки до 2 секунд, Со слов матери объем мочи меньше обычного. Масса тела снижена на 8%. 2. Какие неотложные мероприятия следует провести?!}

Pdf-img/38539692_133631651.pdf-36.jpg" alt="> oral rehydration with glucose-saline solution (Rehydron) at the rate of 80 ml/kg for 6"> пероральная регидратация глюкозо-солевым раствором (регидрон) из расчета 80 мл/кг за 6 часов госпитализация в инфекционный стационар!}

Pdf-img/38539692_133631651.pdf-37.jpg" alt="> Problem 6. An 8-year-old child has"> Задача 6. У ребенка 8 лет во время лечения у стоматолога после проведения анестезии появились жалобы на головную боль, нарастающую слабость, заложенность носа, затруднение дыхания, боли в животе. При осмотре кожные покровы бледные, отмечаются элементы крапивницы, пульс слабого наполнения, 145 в минуту, систолическое давление 30 мм. рт. ст. , диастолическое не определяется. 1. Как следует расценить развившееся состояние?!}

Pdf-img/38539692_133631651.pdf-38.jpg" alt=">Anaphylactic shock.">!}

Pdf-img/38539692_133631651.pdf-39.jpg" alt="> Problem 6. An 8-year-old child has"> Задача 6. У ребенка 8 лет во время лечения у стоматолога после проведения анестезии появились жалобы на головную боль, нарастающую слабость, заложенность носа, затруднение дыхания, боли в животе. При осмотре кожные покровы бледные, отмечаются элементы крапивницы, пульс слабого наполнения, 145 в минуту, систолическое давление 30 мм. рт. ст. , диастолическое не определяется. 2. Какие неотложные мероприятия следует провести?!}

Pdf-img/38539692_133631651.pdf-40.jpg" alt="> ANAPHYLACTIC REACTIONS Emotional and involuntary motor restlessness, “fear of death”"> АНАФИЛАКТИЧЕСКИЕ РЕАКЦИИ Эмоциональное и непроизвольное двигательное беспокойство, «страх смерти» Внезапный кожный зуд, осиплость голоса, связанные с приемом пищи, лекарственных препаратов, укусом насекомых. Осложненный аллергологический анамнез. АНАФИЛАКТИЧЕСКАЯ РЕАКЦИЯ 1. Прекратить поступление аллергена в организм 2. Уложить ребенка горизонтально 3. Оценить окраску кожи и слизистых оболочек, распространенность цианоза 4. Измерить артериальное давление 5. Отметить характер одышки!}

Pdf-img/38539692_133631651.pdf-41.jpg" alt="> Crimson face, severe pallor of the skin, ashy cyanotic lips and nails"> Багровое лицо, резкая бледность кожи, пепельно – цианотичные губы и ногти Артериальная гипотония Тахикардия АНАФИЛАКТИЧЕСКИЙ ШОК 1. Адреналин 1: 1000 – 0, 01 мг/кг 2. Преднизолон – 5 мг/кг в/м в мышцы дна полости рта 3. Доступ к вене: глюкозо – солевой раствор 20 мл/кг/ч в/в 4. При отеке гортани – мероприятия по восстановлению ее проходимости. 5. Оксигенотерапия 6. Вызов реаниматолога!}

Pdf-img/38539692_133631651.pdf-42.jpg" alt="> Emergency measures for anaphylactic shock: laying the patient on his back with raised arms"> Неотложные мероприятия при анафилактическом шоке укладка больного на спине с приподнятыми ногами введение в/в, в/м или п/к раствора адреналина 1: 1000 - 0, 1 мл/кг, при необходимости - повторно через 10 -15 минут введение преднизолона в дозе 2 мг/кг (или другого глюкокортикоида), при необходимости - повторно через 10 -15 минут ингаляция сальбутамола, госпитализация в отделение реанимации!}

Pdf-img/38539692_133631651.pdf-43.jpg" alt="> Task 8 A 1.5 year old child has ARVI"> Задача 8 У ребенка 1, 5 лет на фоне ОРВИ ночью отмечено появление грубого «лающего» кашля, шумного дыхания, при крике – голос осиплый. Мальчик беспокоен, цианоз носогубного треугольника. 1. Как следует расценить развившееся состояние?!}

Pdf-img/38539692_133631651.pdf-44.jpg" alt="> Acute stenotic laryngotracheitis (larynx stenosis, “false” croup) against the background"> Острый стенозирующий ларинготрахеит (стеноз гортани, «ложный» круп) на фоне ОРВИ!}

Pdf-img/38539692_133631651.pdf-45.jpg" alt="> Laryngeal stenosis (croup syndrome) I degree"> Стеноз гортани (синдром крупа) I степень (компенсация) – грубый кашель, несколько затрудненное дыхание при бодрствовании, ДН – нет II степень (субкомпенсация) – беспокойство, шумное дыхание с участием вспомогательной мускулатуры уступчивых мест, инспираторная одышка, периоральный цианоз, «лающий кашель» III степень (декомпенсация) – усиление всех симптомов, резкая инспираторная одышка, исчезает кашель, бледность кожи, цианоз губ, акроцианоз, потливость, агрессивнос тахикардия IV степень (терминальная) – поверхностное дыхание, пульс слабый, иногда не определяется, тоны сердца глухие, резкая бледность кожи, может быть судороги, нарушение ритма дыхания. Асфиксия!}

Pdf-img/38539692_133631651.pdf-46.jpg" alt="> Task 8 A 1.5 year old child has ARVI"> Задача 8 У ребенка 1, 5 лет на фоне ОРВИ ночью отмечено появление грубого «лающего» кашля, шумного дыхания, при крике – голос осиплый. Мальчик беспокоен, цианоз носогубного треугольника. 2. Какие неотложные мероприятия следует провести?!}

Pdf-img/38539692_133631651.pdf-47.jpg" alt="> ACUTE STENOSING LARYNGOTRACHEITIS (OSLT) 1. Calm the child, limit negative"> ОСТРЫЙ СТЕНОЗИРУЮЩИЙ ЛАРИНГОТРАХЕИТ (ОСЛТ) 1. Успокоить ребенка, ограничить отрицательные эмоции 2. Теплое щелочное питьё 3. Паровые ингаляции с содой, создание эффекта «тропической атмосферы» 4. Ингаляции муколитических препаратов, β 2 - агонистов и ипротропиума бромида (беродуал, атровент), рацемического адреналина (разведение 1: 8) 5. Ингаляционные кортикостероиды (пульмикорт) 6. Отвлекающая терапия (горячие ванны общие или для рук и ног, компресс на область гортани) 7. Анемизирующие капли в нос 8. Антигистаминные препараты 9. При нарастающих явлениях стеноза – глюкокортикостероиды парентерально 10. Лечение основного заболевания!}

Pdf-img/38539692_133631651.pdf-48.jpg" alt=">Broncho-obstruction">!}

Pdf-img/38539692_133631651.pdf-49.jpg" alt=">Acute obstructive bronchitis dry cough wheezing expiratory shortness of breath"> Острый обструктивный бронхит сухой кашель свистящее дыхание экспираторная одышка сухие и влажные хрипы в легких Лечение: Ø Бронхолитики Ø Муколитические и отхаркивающие средства Ø Вибромассаж и постуральный дренаж!}

Pdf-img/38539692_133631651.pdf-50.jpg" alt=">Broncholytic therapy in children β 2 - short-acting agonists (salbutamol, phenterol)"> Бронхолитическая терапия у детей β 2 – агонисты короткого действия (сальбутамол, фентерол) Антихолинэргические препараты (ипратропиума бромид) Комбинированные (ипратропиума бромид+фенотерол=Беродуал)!}

Pdf-img/38539692_133631651.pdf-51.jpg" alt="> Berodual (inhalation via nebulizer) 0 -5 years: 1"> Беродуал (ингаляции через небулайзер) 0 -5 лет: 1 капля/кг массы 3 -4 раза в сутки 5 лет и старше: 2 капли/год жизни 3 -4 раза в сутки +2 -3 мл физ. раствора!}

Pdf-img/38539692_133631651.pdf-52.jpg" alt=">Budesonide (Pulmicort) suspension (250 mcg/ml, 500 mcg/ml) Children from 6 months: 0."> Будесонид (Пульмикорт) суспензия (250 мкг/мл, 500 мкг/мл) Дети с 6 месяцев: 0, 25 -1 мг/сут 2 -3 ингаляции в сутки Доза зависит от тяжести БОС Ингаляция ГКС через 15 -20 мин. после ингаляции бронхолитика !При ОСЛТ – до 2 мг ингаляционно!!}

Pdf-img/38539692_133631651.pdf-53.jpg" alt=">Nebulizer inhalations for children PARI Junior. BOY S">!}

Pdf-img/38539692_133631651.pdf-54.jpg" alt="> Indications for hospitalization of children with BOS that developed against the background of ARVI:"> Показания для госпитализации детей с БОС, развившемся на фоне ОРВИ: Неэффективность проведения лечения в домашних условиях в течение 1 -3 часов Выраженная тяжесть состояния больного Дети из групп высокого риска осложнений По социальным показаниям При необходимости установления природы БОС и подбора средств терапии при впервые возникших приступах удушья!}

Pdf-img/38539692_133631651.pdf-55.jpg" alt="> ACUTE UPPER AIRWAY OBSTRUCTION INSPIRATIONAL DYSPHERENE, SIGNS"> ОСТРАЯ ОБСТРУКЦИЯ ВЕРХНИХ ДЫХАТЕЛЬНЫХ ПУТЕЙ ИНСПИРАТОРНАЯ ОДЫШКА, ПРИЗНАКИ УСИЛЕНИЯ РАБОТЫ ДЫХАНИЯ, ГИПОКСИИ ПРЕОБЛАДАЕТ НАРУШЕНИЕ ДЫХАНИЯ, СТЕНОЗ ВДП ПРЕОБЛАДАЕТ НАРУШЕНИЕ ГЛОТАНИЯ ВНЕЗАПНОЕ ПОСТЕПЕННОЕ НАЧАЛО ИНТОКСИКАЦИЯ, t>=38 С НАЧАЛО С ИНФЕКЦИОННОЙ ПРОДРОМОЙ САЛИВАЦИЯ, ВЫНУЖДЕННОЕ ПОЛОЖЕНИЕ АФОНИЯ ГОЛОВЫ, БОЛЬ ПРИ ГЛОТАНИИ РАНО, ФОН ЕСТЬ НЕТ ДН ПОЗДНЕЕ ЗДОРОВ ОТЯГОЩЕН ОСМОТР ЗЕВА РЫХЛЫЙ, ЗНАЧИТЕЛЬНЫЙ КАШЕЛЬ ГИПЕРЕМИРОВАН ОТЕК ЗЕВА И 1 -СТОРОННИЙ ОТЕК ОТЕК, ВЫБУХАНИЕ, ПОДЧЕЛЮСТНЫХ РАХИТ, АЛЛЕРГИЯ, МИНДАЛИН, НЕБНЫХ ГИПЕРЕМИЯ Л/У, СЕРЫЕ СПАЗМОФИЛИЯ, ПОВТОР ОСЛТ ДУЖЕК, ВЫБУХАНИЕ, ЗАДНЕЙ СТЕНКИ НАЛЕТЫ, «ПЕТУШИНЫЙ» ПРИСТУПА ГИПЕРЕМИЯ ГЛОТКИ НЕПРИЯТНЫЙ КРИК ЗАПАХ СЕРЫЙ НАЛЕТ НА ПЕРИТОНЗИ МИНДАЛИНАХ, ИНОРОДНОЕ t>=38, 5 С. ЛЯРНЫЙ ГЕПАТОСПЛЕНОМЕГА АЛЛЕРГИЧЕСКИЙ ОТЕЧНЫЙ ЯРКО- ТЕЛО, ВДП АБСЦЕСС ЛИЯ, СЫПЬ, ОТЕК ГОРТАНИ МАЛИНОВЫЙ ДИФТЕРИЯ ЛИМФАДЕНОПАТИЯ НАДГОРТАННИК ЛАРИНГОСПАЗМ ЗЕВА И ЗАГЛОТОЧНЫЙ ГОРТАНИ ЭПИГЛОТТИТ МОНОНУКЛЕОЗ АБСЦЕСС ГИСТАМИНОЛИТИК ПРОТИВОДИФТЕРИЙНАЯ ООТВЛЕКАЮЩАЯ СЫВОРОТКА, В/М ПРЕДНИЗОЛОН ТЕРАПИЯ ПЕНИЦИЛЛИН В/В 10% р-р Ca. Cl 2 0, 5 мл/кг ЛЕВОМИЦИТИН В/М 25 МГ/КГ. АБ ГРУППЫ ПЕНИЦИЛЛИНОВ. СЕДУКСЕН 0, 3 г/кг ИНФУЗИОННАЯ ТЕРАПИЯ В ПРИ ДН – НАЗОФАРИНГЕАЛЬНЫЙ ПОЛОЖЕНИИ СИДЯ ВОЗДУХОВОД!}

Pdf-img/38539692_133631651.pdf-56.jpg" alt=">ACUTE BRONCHIAL OBSTRUCTION SYNDROME IN YOUNG CHILDREN Child up to"> СИНДРОМ ОСТРОЙ БРОНХИАЛЬНОЙ ОБСТРУКЦИИ У ДЕТЕЙ РАННЕГО ВОЗРАСТА Ребенок до 3 лет (экспираторная одышка, признаки усиленной работы дыхания, гипоксии, аускультативно большое количество сухих и влажных разнокалиберных хрипов, эмфизема) Признаки ЗСН: чрезмерная тахикардия, Нет гепатомегалия, «влажное» легкое. Осложнения Гипероксидная проба+/- перинатального периода, в анамнезе длительная Исключайте «Сердечная кислородозависимость 5 -7 сут ОРВИ, кашель, Есть распространенные сухие кардит, токсикоз астма» детей и локализованные Кишша раннего возраста мелкопузырчат. хрипы Есть Вирусно- Диуретики: Нет бактериальный лазикс+верошпирон. К- эндобронхит препараты, Клинико- 1 -2 сут ОРВИ, распростр. функциональные Есть СГ-насыщение. мелкопузырчатые хрипы, признаки Оксигенотерапия 1 -й приступ СОБО гидроцефально- 1 -2 сут ОРВИ, распростр. RS, парагрипп? гипертензионного Нет Аэрозоль с антибиотиками, синдрома мелкопузырчатые хрипы, Бронхиолит муколитики, отхаркивающие повторные приступы СОБО средства, щелочное питье Нет Есть Симптоматический бронхиолоспазм Бронхиолит с УЗ-аэрозоль. Рибоварин реагиновым 20 мг/мл ОДН компонентом 6 -12 ч. Оксигенотерапия Оксигенотерапия, в/м лазикс 1 мг/кг. Терапия острого приступа БА Госпитализация в СО Эуфиллин 4 мг/кг в/в!}

Pdf-img/38539692_133631651.pdf-57.jpg" alt=">Obstruction of the airways by a foreign body">!}

Pdf-img/38539692_133631651.pdf-58.jpg" alt="> SUSPECTED ASPIRATION OF A FOREIGN BODY IN THE LARRYNX OR TRACHEA"> ПОДОЗРЕНИЕ НА АСПИРАЦИЮ ИНОРОДНОГО ТЕЛА ГОРТАНИ ИЛИ ТРАХЕИ У предварительно здорового ребенка во время еды или игры внезапное ухудшение состояния с приступом навязчивого кашля, рвота, затем разлитой цианоз, асфиксия и утрата сознания Инородное тело Осмотр ротоглотки не видно «Выдвинуть» нижнюю челюсть ребенка, провести 2 -3 пробных экспираторных вдоха Движение грудной клетки ребенка во время искусственного вдоха, дыхательные шумы аускультативно Удалить Конико- или инородное Нет Есть трахеотомия тело Применить прием механического «выбивания» инородного тела Осмотреть ротоглотку Инородное тело есть Инородного тела нет Удалить Продолжать искусственное инородное дыхание тело и интубировать трахею Мероприятия АВС реанимации. Срочная помощь реаниматолога!}

Pdf-img/38539692_133631651.pdf-59.jpg" alt="> For children over 1 year old, perform the Heimlich maneuver. Procedure:"> У детей старше 1 года выполняют прием Геймлиха Порядок действий: Встать за спиной ребенка (детей раннего возраста держат на коленях лицом от себя). Одну руку, сжатую в кулак, положить на живот между пупком и мечевидным отростком. Ладонь другой руки положить поверх кулака. Провести несколько резких толчков в эпигастральную область в направлении вверх к диафрагме (не сдавливая грудную клетку).!}

Pdf-img/38539692_133631651.pdf-60.jpg" alt="> The use of the Heimlich maneuver in infants is not recommended,"> Применение приема Геймлиха у грудных детей не рекомендуют, из-за опасности повреждения органов брюшной полости Порядок действий: 1. Ребенка кладут лицом вниз с несколько опущенным головным концом на предплечье 2. Средним и большим пальцами одной руки поддерживать рот ребенка приоткрытым 3. Производят до 5 ударов ладонью другой руки между лопаток. Нельзя пытаться извлечь инородное тело руками, так при этом можно протолкнуть его еще глубже!!}

Pdf-img/38539692_133631651.pdf-61.jpg" alt="> Prehospital resuscitation (Peter Safar's ABC) A (Air ways)"> Реанимация на догоспитальном этапе (Азбука Питера Сафара) А (Air ways) - восстановление проходимости дыхательных путей В (Breath) - обеспечение дыхания и оксигенации С (Circulation) - восстановление кровообращения!}

Pdf-img/38539692_133631651.pdf-62.jpg" alt="> Restoring airway patency, take the patient’s head back,"> Восстановление проходимости дыхательных путей голову больного отвести назад, открыть рот, осмотреть и салфеткой, намотанной на палец, очистить полость рта от инородных предметов Удалить изо рта и глотки слизь и слюну можно с помощью электроотсоса или резиновой груши. выпрямить дыхательные пути за счёт затылочного сгибания головы и подкладывания валика под плечи. приподнять нижнюю челюсть больного, при возможности - установить S-образный воздуховод.!}

Pdf-img/38539692_133631651.pdf-63.jpg" alt="> Providing respiration and oxygenation using non-apparatus expiratory ventilation method"> Обеспечение дыхания и оксигенации безаппаратная экспираторная вентиляция способом «изо рта в рот» или «изо рта в нос и рот» при возможности используется мешок Амбу!}

Pdf-img/38539692_133631651.pdf-64.jpg" alt=">Artificial ventilation using an Ambu bag">!}

Pdf-img/38539692_133631651.pdf-65.jpg" alt="> Restoring blood circulation, lay the patient on his back on a hard surface. closed"> Восстановление кровообращения уложить больного на спину на твердую поверхность. закрытый массаж сердца: § детям первых месяцев жизни - пальцами обеих рук, большие пальцы кладутся на нижнюю треть грудины, а остальные помещают на спину § Детям до 5 -7 лет - одной рукой, проксимальную часть ладони накладывают на нижнюю треть грудины § Детям старше 7 лет - проксимальными частями обеих кистей, сложенными крест накрест. Частота сжатий грудной клетки должна соответствовать частоте сердечных сокращений у ребенка определенного возраста - от 80 до 120 в минуту.!}

Pdf-img/38539692_133631651.pdf-66.jpg" alt=">CLOSED HEART MASSAGE IN CHILDREN Age Method Hand position Depth"> ЗАКРЫТЫЙ МАССАЖ СЕРДЦА У ДЕТЕЙ Возраст Метод Положение рук Глубина Частота, спасающего на груди вдавления в мин ребенка грудной клетки Концами двух пальцев На ширину одного пальца До 1 года 1 – 2 см 100 ниже сосковой линии Одной ладонью Нижняя треть 1 – 7 лет 2 – 3 см 80 – 100 грудины Кисти обеих рук Старше Нижняя треть 4 – 5 см 80 10 лет грудины!}

Pdf-img/38539692_133631651.pdf-67.jpg" alt="> CARDIO-PULMONARY RESUSCITATION Assess the clinical manifestations of TS"> СЕРДЕЧНО – ЛЕГОЧНАЯ РЕАНИМАЦИЯ Оцените клинические проявления ТС 1. Механически удалите из ротовой полости и глотки слизь и рвотные массы 2. Фиксируйте голову в строго сагиттальном положении и не А. Airways разгибайте (при подозрении на травму шейного отдела Очистка дыхательных путей позвоночника) или слегка запрокиньте ее и выпрямите и создание их свободной дыхательные пути проходимости 3. Выдвиньте вперед нижнюю челюсть ребенка 1. Провести 2 -3 искусственных вдоха («изо рта в рот» или «изо рта в рот и нос»), оцените движение грудной клетки (проведение и глубина дыхания). 2. При возможности перейдите на дыхание через маску с В. Breathing помощью мешка Амбу, системы Айра с добавлением Обеспечение дыхания кислорода. 3. ЧД искусственного дыхания-соответствует возрастной ЧД, глубина-движение грудной клетки, подобно возрастному глубокому вдоху. 4. Контроль – уменьшение степени цианоза С. Circulation 1. Оцените пульс, аускультативно ЧСС и АД Восстановление 2. При отсутствии пульса на бедренной или кровообращения сонной артерии начинайте ЗМС. (циркуляции) 3. Соотношение ЗМС: ИВЛ – 4: 1!}

Pdf-img/38539692_133631651.pdf-68.jpg" alt="> Basic support for vital functions">!}

Pdf-img/38539692_133631651.pdf-69.jpg" alt=">Basic support of vital functions in young children">!}

Pdf-img/38539692_133631651.pdf-71.jpg" alt="> POLYTRAUMA 1. Eliminate the effect of the traumatic agent 2. Assess the child’s condition,"> ПОЛИТРАВМА 1. Устранить действие травмирующего агента 2. Оценить состояние ребенка, осмотреть его 3. Привлекая помощника или самостоятельно вызвать скорую медицинскую помощь 4. Остановить наружное кровотечение, наложить повязки 5. Обеспечить проходимость дыхательных путей 6. Оценить состояние витальных функций 7. Оценить уровень сознания 8. Придать пострадавшему необходимое в зависимости от вида травмы положение 9. Измерить АД, пульс (при необходимости провести СЛР) 10. Контролировать состояние ребенка до прибытия скорой медицинской помощи.!}

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Pdf-img/38539692_133631651.pdf-73.jpg" alt="> ACUTE INFECTIOUS TOXICOSIS IN CHILDREN Neurotoxicosis is a severe form of encephalic reaction due to"> ОСТРЫЙ ИНФЕКЦИОННЫЙ ТОКСИКОЗ У ДЕТЕЙ Нейротоксикоз – тяжелая форма энцефалической реакции вследствие инфекционного и токсического повреждения ЦНС. 1. При гипертермическом синдроме - парацетамол 10 -15 мг/кг или ибупрофен (детям старше 3 месяцев) 5 -10 мг/кг внутрь, или 50% р-р анальгина в дозе 0, 1 -0, 2 мл/год жизни в/м или в/в. 2. При менингеальном синдроме – преднизолон 2 -3 мг/кг в/в или в/м. лазикс 1 -3 мг/кг в/в или в/м. 3. При судорогах – бензодиазепины (седуксен, реланиум, диазепам) в дозе 0, 2 -0, 5 мг/кг в/в медленно, лазикс 1 -3 мг/ в/в, преднизолон 2 -3 мг/кг в/в. 4. Эндотелиотропная терапия – L-лизина эсцинат у детей в возрасте 1 -5 лет 0, 22 мг/кг, 5 -10 лет – 0, 18 мг/кг, 10 -14 лет – 0, 15 мг/кг, старше 14 лет – 0, 12 мг/кг с 0, 9% р-ром натрия хлорида в/в медленно. 5. Госпитализация в ОИТ.!}

Pdf-img/38539692_133631651.pdf-74.jpg" alt="> ACUTE HEART FAILURE Emergency care should begin immediately,"> ОСТРАЯ СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬ Неотложная помощь должна начинаться немедленно, чтобы избежать отека легких и угнетения дыхательного центра. 1. Вызвать скорую медицинскую помощь 2. Обеспечить полный покой в постели с приподнятым изголовьем. 3. Освободить от стесняющей одежды. 4. Респираторная терапия: при наличии умеренно выраженной одышки и акроцианоза – ингаляция 100% кислорода с темпом 10 - 12 л/мин. ; при резко выраженной одышке и цманозе, отсутствии или патологических типах дыхания – после предварительной премедикации 0, 1% метацина 0, 1 мл/год жизни (не более 0, 5 мл) в/в, кетамина 5 мг/кг в/в – интубация трахеи и перевода на ИВЛ. 5. Регуляция преднагрузки: 2% папаверин 1 мг/кг и 1% дибазол 0, 1 - 1 мл в/в; при асистолии – реанимационные мероприятия. 6. Срочная госпитализация в ОИТ.!}

Pdf-img/38539692_133631651.pdf-75.jpg" alt="> PULMONARY BLEEDING Cough with bright red frothy blood,"> ЛЕГОЧНОЕ КРОВОТЕЧЕНИЕ Кашель с ярко - красной пенистой кровью, вызванный глоточными и гортанными рефлексами при кровотечении из носа и верхних отделов пищеварительного тракта Подозрение на легочное кровотечение 1. Придать ребенку полусидячее положение 2. Успокоить ребенка 3. Не давать горячую пищу, чай 4. Оценить витальные признаки: Окраску кожи и слизистых оболочек Характер дыхания Пульс АД 5. Осмотрите полость рта и носоглотку (источник кровотечения), оцените характер теряемой крови 6. Обеспечьте свободную проходимость ВДП 7. Положить пузырь со льдом или холодной водой на грудь 8. Соберите анамнез!}

Pdf-img/38539692_133631651.pdf-76.jpg" alt="> NOSELEED 1. Calm the child 2. Give him"> НОСОВОЕ КРОВОТЕЧЕНИЕ 1. Успокоить ребенка 2. Придать ему сидячее или полусидячее положение, голову ребенка слегка наклонить вперед 3. В носовые ходы вставить марлевые тампоны, обильно смоченные 3% перекисью водорода. 4. Прижать крылья носа к носовой перегородке на 10 -15 минут 5. Холод на переносицу 6. Собрать анамнез при носовом кровотечении НЕЛЬЗЯ: Сморкаться Запрокидывать голову Тампонировать нос ватой!}

Pdf-img/38539692_133631651.pdf-77.jpg" alt="> LOSS OF CONSCIOUSNESS (DEPTH OF COMA) CHILD WITHOUT"> УТРАТА СОЗНАНИЯ (ГЛУБИНА КОМЫ) РЕБЕНОК БЕЗ ЦЕЛЕНАПРАВЛЕННАЯ РЕАКЦИЯ НА БОЛЬ СОЗНАНИЯ НЕТ ИЛИ ЕСТЬ НЕДИФФЕРЕНЦИРОВАНА ПРЕКОМА РЕФЛЕКСЫ С РОТОГЛОТКИ КОМА НЕТ ТЕРАПИИ НЕ ТРЕБУЕТ. ЕСТЬ ТАКТИКА В ЦЕНТРАЛЬНЫЕ НАРУШЕНИЯ ДЫХАНИЯ И ГЕМОДИНАМИКИ ЗАВИСИМОСТИ ОТ ПРИЧИНЫ ЕСТЬ НЕТ КОМА III ОЧИСТКА ВДП; КОМА I КОМА II ИВЛ МАСКОЙ 100% КИСЛОРОДОМ В ОКСИГЕНОТЕРАПИЯ; РЕЖИМЕ ГИПЕРВЕНТИЛЯЦИИ; ДОСТУП К ВЕНЕ; ТРОПИН 0, 1% 0, 1 МЛ/ГОД ЖИЗНИ; АТРОПИН 0, 1% 0, 1 МЛ/ГОД ЖИЗНИ; ДРУГАЯ ПОМОЩЬ В ИНТУБАЦИЯ ТРАХЕИ; ИНТУБАЦИЯ ТРАХЕИ ЧЕРЕЗ ЗАВИСИМОСТИ ОТ ПРИЧИНЫ ДОСТУП К ВЕНЕ; ИНТУБАЦИОННУЮ ТРУБКУ; КОМЫ; ДРУГАЯ ПОМОЩЬ В ЗАВИСИМОСТИ ОТ ДОСТУП К ВЕНЕ; ГОСПИТАЛИЗАЦИЯ В ПРИЧИНЫ КОМЫ; ИНФУЗИОННАЯ ТЕРАПИЯ 30 -40 ПОЛОЖЕНИИ НА БОКУ В ГОСПИТАЛИЗАЦИЯ В МЛ/КГ/ЧАС ДО СТАБИЛИЗАЦИИ АД; РЕАНИМАЦИОННОЕ ОТДЕЛЕНИЕ ЕСЛИ АД НЕ СТАБИЛИЗИРОВАНО- ВВЕДЕНИЕ АДРЕНОМИМЕТИКОВ В/В; ПРЕДНИЗОЛОН 3 МГ/КГ; ПРОБА НА ПЕРЕКЛАДЫВАНИЕ ДРУГАЯ ПОМОЩЬ В ЗАВИСИМОСТИ ОТ ПРИЧИНЫ КОМЫ СОСТОЯНИЕ СТАБИЛЬНО НЕ СТАБИЛЬНО БОЛЬНОЙ НЕ ТРАНСПОРТАБЕЛЕН, ПРОДОЛЖИТЬ МЕРОПРИЯТИЯ ПО ГОСПИТАЛИЗАЦИЯ В РЕАНИМАЦИОННОЕ ОТДЕЛЕНИЕ СТАБИЛИЗАЦИИ СОСТОЯНИЯ!}

Pdf-img/38539692_133631651.pdf-78.jpg" alt="> BURNS 1. Eliminate the damaging factor 2. Release"> ОЖОГИ 1. Устранить действие повреждающего фактора 2. Освободите поврежденный участок тела от одежды (разрезать). 3. Наложите на рану асептическую повязку 4. При химическом ожоге охладить обожженную часть тела под струей холодной воды (за исключением ожогов известью)или приложением холода. 5. Дать пострадавшему теплое питье. 6. Обеспечить покой. Запрещается Вскрывать ожоговые пузыри Срывать с пораженной поверхности части обгоревшей одежды Наносить на пораженные участки мази, жиры.!}

Pdf-img/38539692_133631651.pdf-79.jpg" alt="> INHALATION INJURY 1. It is necessary to ensure that the scene of the accident does not pose a danger. 2."> ИНГАЛЯЦИОННЫЕ ПОВРЕЖДЕНИЯ 1. Необходимо убедиться, что место происшествия не представляет опасности. 2. При необходимости следует использовать индивидуальные средства защиты. 3. Изолировать пострадавшего от воздействия газа или паров, для этого нужно вынести пострадавшего на свежий воздух. 4. Освободить пострадавшего от стесняющей дыхательные движения одежды (ремень, пояс и др.), вынести на свежий воздух. 5. Придать пострадавшему, находящему в сознании, полусидячее положение. 6. При отсутствии сознания необходимо придать пострадавшему устойчивое боковое положение, а при отсутствии дыхания надо приступить к проведению сердечно-легочной реанимации в объеме компрессий грудной клетки и искусственной вентиляции легких.!}

Pdf-img/38539692_133631651.pdf-80.jpg" alt="> OVERHEATING Eliminate exposure to heat by moving the child to a shaded or cool place"> ПЕРЕГРЕВАНИЕ Устранить воздействие тепла, переместив ребенка в тень или прохладное помещение Уложить в горизонтальное положение Освободить его от одежды Голову покрыть пеленкой, смоченной холодной водой Производить частое обмахивание При начальных проявлениях теплового удара и сохраненном сознании дать обильное питье глюкозо-солевым раствором не менее объема возрастной суточной потребности в воде. 1/2 ч. л. натрия хлорида (соль) 1/2 ч. л. натрия гидрокарбоната, 2 ст. л. сахара на 1 л воды!}

Pdf-img/38539692_133631651.pdf-81.jpg" alt="> FREEZING 1. Bring the child into a warm room 2."> ЗАМЕРЗАНИЕ 1. Внести ребенка в теплое помещение 2. Снять с него холодную, мокрую одежду и обувь 3. Уложить ребенка в теплую постель 4. Контролировать дыхание, пульс 5. Если ребенок в сознании напоить его теплым (не горячим) сладким чаем 6. Наложить на пораженную часть тела термоизолирующую ватно-марлевую повязку Нельзя оставлять ребенка на улице и растирать его снегом, спиртом! Нельзя прикладывать к пораженному участку грелку - согревание должно происходить постепенно! Нельзя погружать в горячую ванну!}

Pdf-img/38539692_133631651.pdf-82.jpg" alt="> ELECTRICAL INJURY Disconnect the electric current from the power supply, i.e."> ЭЛЕКТРОТРАВМА Отключите электрический ток из электросети, т. е. выключите рубильник (если возможно) Если Вы не можете этого сделать, встаньте на изолирующий материал: резиновый коврик, сухие газеты. Отдалите ребенка от источника электрического тока (пытайтесь отсоединить кабель от ребенка, а не руку ребенка), для этого используйте сухой предмет, который не проводит ток: деревянная палка, ручка веника, резиновые перчатки. Если рядом ничего подходящего нет, попытайтесь сделать преграду, насколько сможете, рукой, обвернув ее в сухую бумагу или одежду. Держитесь только за одежду ребенка, избегайте контакта с его кожей. Посмотрите, в сознании ли ребенок: Да Нет Успокоить ребенка Проверить есть ли Уложить удобно дыхание Проверить нет ли симптомов шока Да Нет Осмотрите участки, которые контактировали с источником Положить в ИВЛ электрического тока и землей - нет ли безопасную позицию там ожогов. Если вы их обнаружили, окажите первую помощь.!}

Pdf-img/38539692_133631651.pdf-83.jpg" alt="> DROWNING 1. Stop the flow of water into the respiratory tract."> УТОПЛЕНИЕ 1. Прекратить поступление воды в дыхательные пути. 2. Освободить полость рта и верхние дыхательные пути от воды, песка (ила, водорослей), воспользовавшись марлевым тампоном, носовым платком или другой мягкой тканью. 3. Создать дренажное положение для удаления воды – перегнуть пострадавшего ребенка через свое согнутое бедро лицом вниз и нанести удары ладонью между лопатками или приподнять, обхватив руками под эпигастральную область, надавливая на нижние отделы грудной клетки. Этим методом не пользуются, если остановка дыхания и сердечной деятельности имеет рефлекторный характер. 4. Приступить к проведению искусственного дыхания и по показаниям к комплексной сердечно-легочной реанимации по общим правилам при клинической смерти. Если самостоятельное дыхание и сердечная деятельность не восстанавливаются, то реанимацию продолжают 30 – 40 мин. 5. Если сознание у ребенка сохранено: снять мокрую одежду, растереть спиртом и тепло укутать; дать горячее питье;!}

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Specialty 02/34/01. Nursing basic training

“Emergencies in children. Rules and principles of first aid for clinical signs of these conditions, nursing measures and criteria for assessing their practical effectiveness"

Komsomolsk-on-Amur - 2015

1. Introduction

2. Emergency conditions in children

2.1 Hyperthermic syndrome

2.2 Convulsive syndrome

2.3 Laryngospasm

2.4 Acute obstructive laryngitis (croup)

2.5 Fainting

2.6 Anaphylactic shock

2.8 Flatulence

2.9 Nosebleeds in children

2.10 Mechanical asphyxia

2.11 Burn shock

2.12 Traumatic brain injury

2.13 Electrical injury

Conclusion

List of used literature

1. INTRODUCTION

The problem of emergency conditions in children occupies one of the central places among all sections of clinical pediatrics. The development of life-threatening conditions in childhood is due to many factors, including anatomical and physiological characteristics, imperfect neurohumoral regulation of body functions, as well as a burdened premorbid background. All this contributes to the formation of “stressed homeostasis” in the child and leads to a rapid breakdown of adaptive and compensatory capabilities when exposed to unfavorable factors.

Each pediatrician must have thorough knowledge and skills related to providing emergency care to a child in critical conditions, serious illnesses and accidents. Success in providing emergency care largely depends on correct diagnosis and selection of the necessary treatment measures. At the same time, determination, efficiency and the ability to organize the necessary assistance are required from the doctor and nurse in order to eliminate the threatening condition.

2. EMERGENCIES IN CHILDREN

2.1 HYPERTHERMIC SYNDROME

Hyperthermic syndrome is understood as an increase in body temperature above 39 °C, accompanied by hemodynamic and central nervous system disorders. It is most often observed in infectious diseases (acute respiratory diseases, pneumonia, influenza, scarlet fever, etc.), acute surgical diseases (appendicitis, peritonitis, osteomyelitis, etc.) due to the penetration of microorganisms and toxins into the child’s body.

A decisive role in the pathogenesis of hyperthermic syndrome is played by irritation of the hypothalamic region as the center of thermoregulation of the body. The ease of occurrence of hyperthermia in children is explained by several reasons: a relatively higher level of heat production per 1 kg of body weight than in adults, since the body surface in children is larger than the volume of tissues that provide heat production; greater dependence of body temperature on ambient temperature; underdeveloped sweating in premature babies, which limits evaporative heat loss.

Clinical picture. With a sudden increase in body temperature, a child experiences lethargy, chills, shortness of breath, refuses to eat, and asks to drink. Sweating increases. If the necessary therapy is not carried out in a timely manner, symptoms of central nervous system dysfunction appear: motor and speech agitation, hallucinations, clonic-tonic convulsions. The child loses consciousness, breathing is rapid and shallow. At the time of convulsions, asphyxia may occur, leading to death. Often, children with hyperthermic syndrome experience circulatory disorders: drop in blood pressure, tachycardia, spasm of peripheral vessels, etc.

For the clinical assessment of hyperthermic syndrome, it is necessary to take into account not only the value of body temperature, but also the duration of hyperthermia, and the effectiveness of antipyretic therapy. An unfavorable prognostic sign is hyperthermia above 40 C. Prolonged hyperthermia is also an unfavorable prognostic sign. The lack of response to antipyretic and vasodilator drugs also has a negative prognostic value.

Intensive therapy. It is carried out in two directions: the fight against hyperthermia and the correction of vital functions of the body.

1. To reduce body temperature, combined treatment should be carried out, using both pharmacological and physical methods of cooling the body.

2. Pharmacological methods include primarily the use of analgin, amidopyrine and acetyl-salicylic acid. Analgin is administered at the rate of 0.1 ml of a 50% solution per 1 year of life, amidopyrine is administered as a 4% solution at a rate of 1 ml/kg. Acetylsalicylic acid (in recent years, more often paracetamol) is prescribed in a dose of 0.05 - 0.1 g/kg (paracetamol 0.05 - 0.2 g/kg). In the treatment of hyperthermia, especially in cases of impaired peripheral circulation, vasodilating drugs are used, such as papaverine, dibazole, nicotinic acid, aminophylline, etc.

3. Physical cooling methods are used in the following sequence: opening the child; rubbing the skin with alcohol; applying ice to the head, groin and liver areas; blowing the patient with a fan; washing the stomach and colon with ice water through a tube. In addition, when performing infusion therapy, all solutions are administered cooled to 4 °C.

You should not lower your body temperature below 37.5 °C, since, as a rule, after this the temperature drops on its own.

Correction of violations of vital functions consists of the following components:

1. First of all, you should calm the child. For these purposes, midazolam is used at a dose of 0.2 mg/kg, diazepam at a dose of 0.3-0.4 mg/kg or a 20% solution of sodium hydroxybutyrate at a dose of 1 ml per year of the child’s life. The use of lytic mixtures, which include droperidol or aminazine in the form of a 2.5% solution of 0.1 ml per year of life and pipolfen in the same dose, is effective.

2. To maintain adrenal function and lower blood pressure, corticosteroids are used: hydrocortisone 3-5 mg/kg or prednisolone 1-2 mg/kg.

3. Correction of metabolic acidosis and water and electrolyte disorders, especially hyperkalemia. In the latter case, glucose infusion with insulin is used.

4. In the presence of respiratory disorders and heart failure, therapy should be aimed at eliminating these syndromes.

When treating hyperthermic syndrome, you should refrain from using vasopressors, atropine and calcium supplements.

2.2 CONVIVUS SYNDROME

Frequent clinical manifestation of central nervous system damage. In children, seizures occur especially often.

A number of endogenous and exogenous factors can lead to the occurrence of seizures: intoxication, infection, trauma, central nervous system diseases. Convulsive syndrome is a typical manifestation of epilepsy, spasmophilia, toxoplasmosis, encephalitis, meningitis and other diseases. Often convulsions occur due to metabolic disorders (hypocalcemia, hypoglycemia, acidosis), endocrine pathology, hypovolemia (vomiting, diarrhea), overheating. In newborns, the causes of seizures can be asphyxia, hemolytic disease, and congenital defects of the central nervous system. Convulsions are often observed with the development of neurotoxicosis, which complicates various diseases in young children, in particular, such as combined respiratory viral infections: influenza, adenoviral, parainfluenza infection.

Clinical picture. Manifestations of convulsive syndrome are very diverse and differ in duration, time of occurrence, state of consciousness, frequency, prevalence, form of manifestation. The nature and type of seizures is greatly influenced by the type of pathological process, which can be the direct cause of their occurrence or play a provoking role.

With convulsive syndrome, the child suddenly loses contact with the environment, his gaze becomes wandering, then the eyeballs are fixed upward or to the side. The head is thrown back, the arms are bent at the hands and elbows, the legs are extended, the jaw is clenched. Possible tongue biting. Breathing and heart rate slow, possibly causing apnea.

Diagnosis. Life history (course of childbirth) and disease history are important. Additional research methods include electroencephalography, echoencephalography, fundus examination and, if indicated, computed tomography of the skull. Lumbar punctures are of great importance in the diagnosis of convulsive syndrome, which make it possible to establish the presence of intracranial hypertension, serous or purulent meningitis, subarachnoid hemorrhage or other diseases of the central nervous system.

Intensive therapy. They adhere to the following basic principles: correction and maintenance of basic vital functions of the body, anticonvulsant and dehydration therapy.

1. If a convulsive syndrome is accompanied by severe disturbances in breathing, blood circulation and water-electrolyte metabolism, which directly threaten the child’s life, intensive therapy should begin with the correction of these phenomena. It is carried out according to general rules and consists of ensuring free patency of the upper respiratory tract, oxygen therapy, and, if necessary, artificial ventilation, normalization of water-electrolyte metabolism and acid-base status.

2. Anticonvulsant therapy is carried out with various drugs depending on the child’s condition and the doctor’s personal experience, but preference is given to drugs that cause the least respiratory depression:

Midazolam (dormicum) is a drug from the group of benzodiazepines that has a pronounced anticonvulsant, sedative and hypnotic effect. Administered intravenously at a dose of 0.2 mg/kg, intramuscularly at a dose of 0.3 mg/kg. When administered rectally through a thin cannula inserted into the ampoule of the rectum, the dose reaches 0.4 mg/kg, and the effect occurs within 7-10 minutes. The duration of action of the drug is about 2 hours, the side effect is minimal;

Diazepam (Seduxen, Relanium) is a safe remedy in emergency situations. It is administered intravenously at a dose of 0.3--0.5 mg/kg; subsequently, half the dose is administered intravenously, half intramuscularly;

Sodium hydroxybutyrate (GHB) has a good anticonvulsant, hypnotic, and antihypoxic effect. It is administered intravenously or intramuscularly in the form of a 20% solution at a dose of 50-70-100 mg/kg or 1 ml per year of the child’s life. It can be used intravenously in a 5% glucose solution to avoid repeated seizures. The combined use of diazepam and sodium oxybutyrate in half dosages is very effective, when their anticonvulsant effect is potentiated and the period of action is extended;

Droperidol or aminazine with pipolfen are administered intramuscularly or intravenously at 2-3 mg/kg of each drug;

A quick and reliable effect is provided by the introduction of a 2% hexenal solution or a 1% sodium thiopental solution; administered intravenously slowly until the seizures stop. It should be borne in mind that these drugs can cause severe respiratory depression. Hexenal can be used intramuscularly in the form of a 10% solution at a dose of 10 mg/kg, which ensures long-term sleep;

If there is no effect from other drugs, you can use nitrous-oxygen anesthesia with the addition of traces of fluorotane;

The last resort to combat convulsive syndrome, especially with manifestations of respiratory failure, is the use of long-term mechanical ventilation along with the use of muscle relaxants, the best of which in this case is Tracrium: it has virtually no effect on hemodynamics and its effect does not depend on the function of the patient’s liver and kidneys . The drug is used as a continuous infusion at a dose of about 0.5 mg/kg per hour;

In newborns and infants, seizures can be caused by hypocalcemia and hypoglycemia, therefore, as anticonvulsants, ex-juvantibus therapy should include a 20% glucose solution at 1 ml/kg and a 10% calcium glucionate solution at 1 ml/kg.

3. Dehydration therapy is carried out according to general rules. Currently, it is believed that in case of convulsions one should not rush to prescribe dehydrating agents. It is advisable to begin dehydration with the administration of magnesium sulfate in the form of a 25% solution intramuscularly at the rate of 1 ml per year of the child’s life. In severe cases, the drug is administered intravenously.

2.3 Laryngospasm

Laryngospasm in children is a sudden involuntary contraction of the muscles of the larynx. Causes complete closure of the glottis and occurs with inspiratory dyspnea. Sometimes it is combined with tracheospasm, when the smooth muscles of the posterior membranous part of the trachea simultaneously contract.

Occurs in children from 3 months of age. up to 3 years, usually at the end of winter or spring as a result of calcium depletion in the blood, which in turn is associated with a deficiency of vitamin D in the body.

Laryngospasm can develop against the background of bronchopneumonia, chorea, spasmophilia, with diseases of the larynx, pharynx, trachea, pleura, gall bladder, with sensitization of the body, for example due to infectious diseases, the introduction of certain medications into the nose (for example, adrenaline).

Laryngospasm develops suddenly, in children - usually during crying, laughing, coughing, or with fear. Noisy, whistling, difficult breathing appears, pallor or cyanosis of the skin is noted, auxiliary respiratory muscles are included in the breathing process, and the neck muscles tense. During an attack, the patient's head is usually thrown back, his mouth is wide open, cold sweat appears, and the pulse is thready.

A temporary cessation of breathing occurs, which is soon restored as a result of overstimulation of the respiratory center by carbon dioxide accumulated in the blood. In mild cases, the attack lasts several seconds and ends with an extended breath. Gradually, breathing returns to normal, and sometimes sleep occurs.

Attacks can be repeated several times a day, usually during the daytime. In severe cases, the attack may be longer, the patient loses consciousness, generalized convulsions, foam at the mouth, involuntary urination and defecation, and weakened cardiac activity appear. With a prolonged attack, death from asphyxia is possible.

Features of care.

During an attack, the patient should be reassured, provided with fresh air, given a drink of water and sniffed with ammonia, sprinkled with cold water on the face, patted the patient on the back, tickled the nose, asked to hold his breath, and artificially induce a gag reflex.

If there is a threat of asphyxia, they resort to tracheal intubation or tracheotomy.

The prognosis is usually favorable. The tendency to laryngospasms in children usually disappears with age.

If the attack does not stop, you need to do an enema of a 2% solution of chloral hydrate in doses:

up to 2 months of age. -- 10 ml.

from 3 to 5 months. -- 10-15 ml.

from 6 months up to 1 year - 15-20 ml.

from 1 year to 3 years - 20-25 ml.

You can inject intramuscularly a sterile solution of 25% magnesium sulfate, 0.2 ml. per 1 kg of child's weight.

Prevention.

Prevention is aimed at eliminating the cause of laryngospasms and timely treatment of the underlying disease against which it usually occurs. Prescribe calcium supplements, vitamins, ultraviolet irradiation, recommend long stays in the fresh air, a dairy-vegetable diet, and feeding infants with mother's milk.

2.4 ACUTE OBSTRUCTIVE LARINGITIS (CROUP)

Croup, also known as viral croup or laryngotracheobronchitis, is a respiratory disease most common among preschool children, most often between the ages of three months and three years. Symptoms of croup include inflammation of the larynx and upper airways, which leads to further narrowing of the airways.

Traditionally, a distinction is made between true croup, which occurs as a result of damage to the true vocal folds (diphtheria croup), and false croup, as a manifestation of stenosing laryngitis of a non-diphtheria nature (viral, spasmodic).

False croup, or acute stenosing laryngotracheitis, is an inflammation of the mucous membrane of the larynx, accompanied by spastic narrowing of the lumen of the larynx, which is characterized by the appearance of a rough “barking” cough, a hoarse or hoarse voice and shortness of breath, often of an inspiratory nature, caused by swelling of the subglottic space.

False croup affects children aged 6 months and older. up to 6 years (usually between the ages of 6 and 36 months). The boys:girls ratio is 1.5:1. The incidence is characterized by seasonality with a peak in late autumn - early winter.

The development of croup is associated with the anatomical and physiological features of the structure of the respiratory tract in children of this age, namely: a relatively narrow lumen of the larynx, a funnel-shaped shape of the larynx, loose fibrous connective and adipose tissue of the subglottic apparatus, which determines the tendency to develop edema, features of the innervation of the larynx and relative weakness respiratory muscles, which are associated with the occurrence of laryngospasm. It should be noted that swelling of the mucous membrane with an increase in its thickness by only 1 mm reduces the lumen of the larynx by half.

Main symptoms of croup:

Inspiratory shortness of breath (stridor) with the development of respiratory failure.

Breathing disorders due to narrowing of the lumen of the larynx most often occur at night, during sleep, due to changes in the conditions of lymph and blood circulation of the larynx, a decrease in the activity of the drainage mechanisms of the respiratory tract, the frequency and depth of respiratory movements. In this regard, the croup is called a “night predator”.

Treatment of croup should be aimed at restoring airway patency by reducing or eliminating spasm and swelling of the laryngeal mucosa, freeing the lumen of the larynx from pathological secretions.

Patients must be hospitalized in a specialized or infectious diseases hospital, preferably in an intensive care unit, but treatment should begin at the prehospital stage.

The child should not be left alone; he must be calmed down and picked up, since forced breathing during anxiety and screaming increases the feeling of fear and the phenomenon of stenosis.

The room temperature should not exceed 18°C. Warm drinks (hot milk with soda or Borjomi), steam inhalations are recommended.

The basis of drug therapy for false croup is glucocorticoid drugs. It is possible to use dexamethasone orally or parenterally, budesonide through a nebulizer, and prednisone in suppositories rectally. In order to thin and remove mucus from the respiratory tract, expectorants and mucolytic drugs are prescribed, administered primarily by inhalation.

2.5 syncope

Fainting is a sudden short-term loss of consciousness caused by acute oxygen deficiency of the brain (hypoxia). Some children and adolescents have a congenital or acquired tendency to faint due to individual characteristics of the reactivity of the nervous and cardiovascular systems.

The causes of fainting are varied. These include factors that cause reflex spasm (constriction) of brain vessels or difficulty in the absorption of oxygen by brain tissue. Fainting can be a consequence of taking certain medications (ganglionic blockers, etc.), one of the manifestations of hysteria (fainting is more common), many diseases of the nervous, endocrine, cardiovascular and other systems, brain injuries and other pathologies. Frills can cause sharp negative emotions caused by fear, sharp conflicts, extremely unpleasant sights, and other negative psycho-emotional effects.

Fainting in children and adolescents usually lasts from a few seconds to 15-30 minutes. If fainting lasts for a short time (from 1-2 seconds to 1-2 minutes), it is called mild. A more prolonged loss of consciousness is assessed as moderate or severe syncope.

First aid for fainting

1. First of all, it is necessary to take measures to improve the blood supply to the victim’s brain. For this purpose, he is given a horizontal position with his head down and legs raised. In this case, it is necessary to free the child from restrictive clothing, unfasten the collar, loosen the belt, open the window or window, and ask all strangers to leave the room.

2. You should also sprinkle your face, neck, chest with cold water, let them smell some stimulating substance (ammonia or acetic acid), rub your body with alcohol or cologne (if you don’t have them, use a dry hand).

3. If, during prolonged fainting, cardiac arrest and breathing occur, immediately begin artificial ventilation of the lungs and closed cardiac massage.

4. During the recovery period, the victim is provided with conditions for maximum mental, emotional and physical peace, he is warmed with heating pads, and given hot sweet tea to drink.

For prolonged fainting, prescribe:

10% solution of caffeine-sodium benzoate 0.1 ml/year of life s.c. or

Cordiamine solution 0.1 ml/year of life s.c.

Hospitalization for fainting of functional origin is not indicated, but if there is a suspicion of an organic cause, hospitalization in a specialized department is necessary.

2.6 ANAPHYLACTIC SHOCK

Anaphylactic shock is a rare and very dangerous reaction to an allergen that has entered the human body. This condition develops very quickly, within a few minutes or hours, and can lead to serious consequences, including irreversible changes in internal organs and death.

Causes of anaphylactic shock

A state of shock occurs in the following cases:

When administering drugs orally, intramuscularly or intravenously;

After a child has been vaccinated;

As a reaction to a sample of an antibacterial drug;

For insect bites;

Very rarely - as an allergy to a food product.

Anaphylactic shock often develops in children who suffer from allergies or have a genetic predisposition to it.

There are two variants of the fulminant course of anaphylactic shock, depending on the leading clinical syndrome: acute respiratory failure and acute vascular failure.

In case of anaphylactic shock with a leading syndrome of respiratory failure, the child suddenly develops and develops weakness, a feeling of constriction in the chest with a feeling of lack of air, a painful cough, a throbbing headache, pain in the heart area, and fear. There is severe pallor of the skin with cyanosis, foam at the mouth, difficult wheezing with dry wheezing when exhaling. Angioedema of the face and other parts of the body may develop. Subsequently, with the progression of respiratory failure and the addition of symptoms of acute adrenal insufficiency, death may occur.

Anaphylactic shock with the development of acute vascular insufficiency is also characterized by a sudden onset with the appearance of weakness, tinnitus, and heavy sweating. There is an increasing pallor of the skin, acrocyanosis, a progressive drop in blood pressure, a thready pulse, and heart sounds are sharply weakened. After a few minutes, loss of consciousness and convulsions are possible. Death occurs with increasing symptoms of cardiovascular failure. Less commonly, anaphylactic shock occurs with the gradual development of clinical symptoms.

The complex of treatment measures must be absolutely urgent and carried out in a clear sequence.

Algorithm of action for providing emergency care for anaphylactic shock in children:

1. Stop administering the substance that caused anaphylaxis.

2. Place the child in a position with the foot end of the bed raised, cover him warmly, cover him with heating pads, turn his head to one side, give him humidified oxygen.

3. Inject the injection site “crosswise” with a 0.1% solution of adrenaline at the rate of 0.1 ml/year of life, diluted in 5 ml of isotonic sodium chloride solution. Apply a tourniquet above the allergen injection site (if possible) for 30 minutes without squeezing the arteries. When introducing an allergenic drug into the nose or eyes, it is necessary to rinse them with water and drip with a 0.1% solution of adrenaline and a 1% solution of hydrocortisone

4. At the same time, inject 0.1% solution of adrenaline (0.1 ml/year of life) into any other part of the body every 10-15 minutes until the condition improves; if it progressively worsens, inject 0.2% solution of norepinephrine intravenously at 20 ml of 5-10% glucose solution.

5. Inject prednisolone (2-4 mg/kg) or hydrocortisone (10-15 mg/kg) intravenously, repeat if necessary after 1 hour.

6. For obstructive syndrome, intravenous injection of 2.4% aminophylline solution 3-4 mg/kg.

7. Inject intramuscularly a 2% solution of suprastin or a 2.5% solution of tavegil (0.1 ml/year of life).

8. For heart failure, 0.06% solution of corglycone (0.01 mg/kg) IV slowly in 10 ml of 10% glucose, Lasix (1-2 mg/kg) IM. Hospitalization is required even if life-threatening conditions disappear due to the possibility of secondary shock. In the hospital, continue the activities indicated above. If necessary, replenish the blood volume by drip injection of a 5% solution of glucose, polyglucin and rheopolyglucin; in the absence of stabilization of blood pressure, a 0.2% solution of norepinephrine (0.5-1 ml), 0.1% solution of mesatone (1- 2 ml), prednisolone (2-4 mg/kg). In severe cases, when breathing stops, the patient is transferred to mechanical ventilation.

After an attack of anaphylactic shock and first aid, treatment should be continued in a hospital setting for 12-14 days.

Vomiting occurs very often in children, especially at an early age. The causes of vomiting are very varied. And, although in some cases they can sometimes be determined by the nature of the vomit, vomiting, as a rule, characterizes conditions that urgently require the attention of a qualified physician.

Vomiting is the sudden emptying of the stomach through the mouth. Vomiting begins “on command” of the vomiting center, which is located in the medulla oblongata. It can be excited by impulses from the stomach, intestines, liver, kidneys, uterus, vestibular apparatus, as well as by irritation of higher nerve centers (for example, vomiting due to unpleasant odors). Vomiting can also occur as a result of the action of various toxic substances and medications on the vomiting center.

In most cases, vomiting is preceded by nausea, increased salivation, and rapid and deep breathing.

The mechanism of vomiting can be schematically described as follows: the diaphragm sequentially descends, the glottis closes (which prevents vomit from entering the respiratory tract), the lower part of the stomach spasms, and the upper part relaxes. Rapid contraction of the diaphragm and abdominal muscles causes the contents of the stomach to be expelled.

The causes of vomiting are varied. These are infectious diseases, diseases of the gastrointestinal tract, surgical diseases, pathology of the central nervous system, etc. Depending on them, vomiting can be single or repeated, abundant or scanty, and appear at certain intervals. By the nature of the vomit (digested or undigested food, mucus, blood, bile), it is sometimes possible to determine the cause of vomiting.

It is also necessary to distinguish between vomiting and regurgitation. Regurgitation usually occurs without effort, tension of the abdominal muscles and diaphragm, and is the result of the stomach being full of food or air.

Vomiting occurs very often in children, especially at an early age. The particular danger of vomiting in children is determined by the fact that in young children the protective mechanisms are imperfect and vomit can enter the respiratory tract.

If a child experiences the following symptoms and vomiting, immediate medical attention is required.

Vomit contains red or brown blood;

Frequent repeated vomiting (more than four times in 2 hours) leads to rapid dehydration;

Vomiting, which is accompanied by high fever, significant lethargy of the child, semi-conscious or unconscious state;

Vomiting that occurs after a child falls, head injury;

Vomiting, which is accompanied by abdominal pain and lack of stool (peristalsis).

If a child vomits, the child should be kept in an upright position. It is advisable to find out the cause of vomiting as soon as possible.

If this phenomenon appears in an infant, it is necessary to check his nose for congestion. In some cases, food comes out because the baby cannot breathe. If such situations arise, you need to immediately clean the child’s nose; this can be done with a medical bulb. In situations where the child’s vomiting continues for more than half an hour and does not calm down, the child should be hospitalized immediately.

In older children, when vomiting, you need to support the upper body, bring a basin, after the end of the attack, wipe the mouth and offer water, and if necessary, change clothes and bedding. If the child is very weak and it is difficult for him to be in a sitting position, then he can be laid down, but in this case his head is turned to the side. This is necessary to prevent vomit from entering the respiratory system.

If a child’s vomiting is caused by poisoning with medications, chemicals, poor-quality food, or due to overeating, the stomach must be rinsed.

Gastric lavage is carried out several times in a row, until the water after rinsing becomes clean and does not contain any impurities.

2.8 Flatulence

emergency children laryngitis fainting

Flatulence is a condition characterized by excessive accumulation of gases in the intestines. Gases are released by bacteria when food ferments, and a child may also swallow air while eating or talking. Flatulence is not a serious or dangerous disease, but it often causes pain and discomfort in the child’s intestines.

The main symptoms of flatulence:

Stomach ache,

Strong rumbling

Belching;

Feeling of a bursting belly,

Increase in abdominal volume.

Normally, a child's stomach and intestines contain about 0.5 liters of gases, which are formed as a result of the activity of microorganisms and are eliminated during bowel movements. With flatulence, the volume of gases produced can reach 1, 5 or more liters, the composition of gases also changes, which can cause belching, hiccups, pain, diarrhea or constipation.

Flatulence is also a common symptom of diseases such as:

Intestinal dysbiosis;

Diseases of the gastrointestinal tract (gastritis, pancreatitis, enteritis, colitis);

Acute intestinal infections;

Inflammatory processes in the intestines;

Frequent constipation;

Emergency care from a nurse for flatulence:

	JUSTIFICATION	DOSES OF MEDICINES
1. Lay the child on his back, free the lower half of the body	Relieving intestinal motility
2. Provide access to fresh air	Providing comfortable conditions
3. Perform a light abdominal massage clockwise	Normalization of peristalsis
4. If there is no effect from previous measures, install a gas outlet tube	Removing gases accumulated in the intestines
5.If there is no effect, administer the following drugs: Activated carbon or "smecta" Intramuscularly cerukal (raglan) or prozerin Note: each subsequent drug should be administered if the previous one is ineffective	Are adsorbents Normalizes intestinal motility	Up to 1 year - 1 sachet per day, 1-2 years - 2 sachets per day, > 2 years - 2-3 sachets per day. (1 ml = 5 mg) 0.1 ml/year
6. Eliminate gas-forming foods from your diet: unleavened milk, carbonated drinks, vegetables, legumes, brown bread and others	Prevention of increased flatulence or recurrence

2.9 NOSELEED IN CHILDREN

Causes of nosebleeds: distinguish between local (trauma, adenoids, foreign body) and general (this is a sign of a general disease: scarlet fever, influenza, hemophilia, leukemia, thrombocytopenic purpura, liver disease, cardiovascular disease).

Providing nursing care:

1. In order to prevent aspiration, swallowing blood and bloody vomiting, sit the child with his head slightly lowered down.

3. To improve lung excursion, loosen tight clothing.

4. Provide access to fresh air to make breathing easier.

5. Create a calm environment.

6. To mechanically stop bleeding, press the wing of the nose to the nasal septum on the corresponding side.

7. Apply cold to the bridge of the nose, the back of the head, and a heating pad to the legs in order to reduce blood flow to the nasal cavity.

8. To ensure local stopping of bleeding, pack the corresponding nasal passage with a cotton swab (you can moisten it in a 3% solution of hydrogen peroxide, adrenaline solution, Vikasol, hypertonic solution, breast milk).

Note:

Hydrogen peroxide has a cauterizing effect;

Adrenaline has a vasoconstrictor effect;

Vikasol, a hypertonic solution, has a hemostatic effect;

Breast milk contains “hemostatic” vitamin K.

9. As prescribed by the doctor, administer hemostatic agents to the child:

10% calcium chloride solution or 10% calcium gluconate solution orally or intravenously;

Vikasol - 0.1 ml/year intramuscularly;

Drugs that strengthen the vascular wall: rutin, ascorbic acid.

10. Determine the cause of nosebleeds and try to eliminate it.

Nosebleeds are a symptom, not a diagnosis.

2.10 MECHANICAL ASPHIXIA

Asphyxia is a state of increasing suffocation caused by a severe lack of oxygen. Lack of oxygen and retention of carbon dioxide in the body lead to disruption of vital organs and systems, primarily the nervous, respiratory and cardiovascular systems. Mechanical asphyxia - develops as a result of the cessation or sharp limitation of air access to the lungs (for example, drowning, compression of the airways by a tumor, entry of a foreign body into the airways).

In the presence of obstructive syndrome, it is necessary to restore the patency of the airways, freeing them from mucus, blood, and vomit. Assistance begins with drainage in an inclined position of the body. To remove a foreign body from the glottis area, two techniques are used - a sharp push into the epigastric region in the direction of the diaphragm or compression of the lower parts of the chest. Small children are tilted forward, their heads are slightly thrown back, and with a blow of the palm the airways are cleared of a stuck foreign body. If there are no independent coordinated respiratory movements, begin artificial respiration using the “mouth to mouth” or “mouth to nose” method.

Mechanical asphyxia includes hanging and drowning.

2.11 BURN SHOCK

Household thermal and chemical burns occur more often in children than in adults due to their less experience and greater curiosity. For example, throwing hot liquids over oneself and touching hot metal objects predominate at the age of 1-3 years.

Due to the anatomical and functional immaturity of the child’s body, pathological changes manifest themselves more sharply than in adults. The skin of children is thin and delicate, so a deep burn in them is caused by a thermal or chemical factor that will only cause a superficial burn in adults. Burn shock can occur in children with a lesion area of 5% and is more severe the younger the child’s age. In adults, burn shock develops when 15-20% of the body surface is affected.

Clinical manifestations:

The injured child is in a serious or extremely serious condition, but usually does not make any complaints, because he is indifferent to everything that is happening, apathetic (the victim’s gaze may seem absent, indifferent). The child may lose consciousness. With a slight shock, the child is characterized by restless behavior, he is excited, but on the contrary, he may be inhibited and lethargic. Characterized by a sudden and quite pronounced pallor of the skin and visible mucous membranes, the child’s skin takes on a grayish, earthy tint. A very typical manifestation of shock is cold, sticky sweat appearing on the skin. As a rule, sweat appears on the face (particularly on the upper lip) and on the palms of the hands, and the affected child may experience numbness in the arms and legs. The pulse is weak and frequent (more than 100 beats per minute); The pulse is either barely palpable or not palpable at all. The breathing of a child in a state of shock is frequent, shallow and uneven. Body temperature drops slightly. There may be a feeling of general weakness. The affected child feels dizzy and thirsty. He experiences nausea and vomiting. The injured child may remain in a severe state of shock for several hours. If help is not provided at this time, the child may die.

The injured child must be given first aid:

1. Pain relief. At the scene of the incident, the doctor may suspect OS based on the patient’s behavior. If the patient (especially a child) screams and worries, this indicates either the erectile phase of burn shock (accompanied by pale skin) or the absence of shock (pink skin). Dyspnea and tachycardia (especially in children) can be psychogenic in nature in the absence of shock. In case of anxiety and screaming, hemodynamics are usually sufficient for absorption of drugs administered intramuscularly. Therefore, in such cases, help begins with an intramuscular (not subcutaneous!) injection of 1% promedol solution (0.1 ml per year of life, no more than 1.5 ml) + 0.25% seduxen solution ( 0.1 ml per year of life, no more than 2 ml) in one syringe (dose calculation, of course, only for pediatrics). Such an injection will not only ease the patient’s suffering, but will also allow him to undress for examination of the burn wounds. Assessment of the area and depth of burns, as well as determination of blood pressure and heart rate confirm (or reject) the diagnosis of OS. If the patient has a torpid phase of OS (lethargy, hypotension), all medications are administered only intravenously.

Indications for hospitalization of patients with burn shock:

1. The area of burns is more than 10% at any age.

2. The area of burns is more than 5% in children under 3 years of age.

3. Burns 3 - 4 tbsp. any area.

4. Burn shock of any degree.

2.12 CRANIO BRAIN INJURY

Traumatic brain injury in children accounts for 30-40% of the total number of traumatic injuries. The mortality rate for isolated traumatic brain injury can reach 38-40%, and for combined traumatic brain injury - 70% or more.

Features of traumatic brain injury in children

1. Rapid development of general cerebral symptoms and depression of consciousness with possible improvement in a short time.

2. Fractures of the skull bones are often observed.

3. White matter ruptures predominate in young children, while contusion lesions are more common in adults and children of older age groups.

Classification.

There are closed and open TBI. With a closed traumatic brain injury there is no damage to the aponeurosis, while with an open traumatic brain injury there is always damage to the aponeurosis.

Open TBI also includes a fracture of the base of the skull.

Regardless of the type, there are six clinical forms of TBI:

1. Concussion.

2. Mild brain contusion.

3. Moderate brain contusion.

4. Severe brain contusion.

5. Compression of the brain due to a bruise.

6. Compression of the brain without accompanying contusion.

Urgent Care.

The scope of therapeutic measures that are necessary at the prehospital stage depends on the degree of depression of consciousness and disruption of basic vital functions - breathing and circulation.

It should be emphasized that, regardless of the nature and severity of the injury, hypoxia, hypercapnia and arterial hypotension must be eliminated at the prehospital stage.

1. For mild TBI not accompanied by depression of consciousness, symptomatic therapy (pain relief, elimination of nausea and vomiting) followed by hospitalization of the patient in a hospital is indicated. The administration of sedatives at the prehospital stage is inappropriate in this case.

2. In patients with severe traumatic brain injury and impaired vital functions, urgent measures are required to ensure airway patency, adequate ventilation and normalization of hemodynamic parameters.

A. Ensuring airway patency.

If consciousness is depressed to the level of coma, tracheal intubation and transfer of the child to mechanical ventilation are indicated, regardless of the duration of transportation.

B. Ensure adequate ventilation and oxygenation.

In case of severe depression of consciousness (stupor, coma) and the presence of signs of inadequate spontaneous breathing, transfer of the child to mechanical ventilation in the mode of moderate hyperventilation is indicated.

B. Ensuring adequate hemodynamics.

The main task of the prehospital stage is to ensure normalization of the volume of circulating blood and stabilization of the main indicators reflecting the state of the cardiovascular system: heart rate, blood pressure, capillary refill time, hourly rate of diuresis, body temperature.

All efforts at the prehospital stage should be aimed at providing adequate infusion therapy and eliminating arterial hypotension, and not at eliminating intracranial hypertension, therefore the administration of diuretics until hypovolemia is eliminated is strictly contraindicated.

The optimal solutions for infusion therapy for TBI at the prehospital stage are 0.9% sodium chloride solution and Ringer lactate.

Indications for hospitalization

1. Depression of consciousness (both at the time of examination and during the injury);

2. Presence of skull fractures;

3. Presence of focal neurological symptoms;

4. Alcohol intoxication, history of epilepsy;

5. Severe headache, vomiting, fever;

6. Convulsions;

7. Oto- and rhinoliquorhea.

2.13 ELECTRICAL INJURY

Electrical injury is damage caused by exposure of the body to high voltage electric current.

The most common causes: child contact with exposed electrical wires and insertion of metal objects into sockets.

Damage can be caused by:

Sources of direct and alternating current (high-voltage AC lines with a power of I - 1.75 kW, railway DC power lines with a power of 1.5 and 3.6 kW);

Static electricity discharges (lightning). More severe electric shocks occur when the child’s skin, clothes and shoes are wet.

The pathological effects of electric current depend on the line of its passage through the victim's body. The most common paths for current passage are: hand - hand, hand - head, hand - leg, leg - leg. Electrical injuries resulting from electric shock in 25% of cases result in the death of the victim.

When an electric current passes through the brain, instant death occurs. When current passes through the heart, various heart rhythm disturbances occur, including ventricular fibrillation. Less severe lesions are characterized by vascular tone disorders. Tonic contractions of the muscles of the skeleton and blood vessels are accompanied by severe pain, leading to shock.

Electric current, in contact with the child’s body, also has a thermal effect, and 3rd degree burns occur at the point of contact. Direct current is less dangerous than alternating current. Alternating current, even at a voltage of 220 volts, can cause very serious damage to the body.

Before treating an electrical injury, be sure to stand on a dry surface, as moisture increases electrical conductivity. When the victim regains consciousness after artificial respiration, he should be given a large amount of liquid (tea, mineral water). The victim should be covered with a blanket and taken to a medical facility as soon as possible. A characteristic feature of electrical burns is their painlessness due to the destruction of sensitive nerve endings.

Providing assistance with electrical injuries in children

1. Free the child from contact with the source of electric current.

2. Lay the child on a horizontal surface, free the chest from constricting clothing.

3. For stage 1 damage: give warm tea, oral analgin, sedatives in age-appropriate dosages.

4. Call the SME team and, with its assistance:

for stage 2 damage: administer a 50% analgin solution at a dose of 0.1 ml/year of life in combination with a 2.5% solution of pipolfen or a 2% solution of suprastin at a dose of 0.1 ml/year of life intramuscularly;

with 3 - 4 degrees of damage - complex cardiopulmonary resuscitation or mechanical ventilation using available methods, closed heart massage.

In case of local manifestations of electrical injury, administer analgesics intramuscularly and apply an aseptic (ointment) bandage.

5. Hospitalization for 2 - 3 - 4 degrees of severity of electrical injury in the intensive care unit. In the 1st degree, if the burn is more than 0.5% of the body surface or the injury is accompanied by charring, hospitalization in the surgical department.

CONCLUSION

The course work examines various emergency conditions in children, such as hyperthermic syndrome, convulsive syndrome, laryngospasm, fainting, acute obstructive laryngitis (croup), anaphylactic shock, vomiting, flatulence, nosebleeds, mechanical asphyxia, burn shock, traumatic brain injury , electrical trauma, their symptoms and causes. Methods of providing emergency care to a child in the above conditions, complications that arise, and indications for hospitalization of a child after providing first emergency care are discussed in detail.

LIST OF REFERENCES USED

1.V.D.Tulchinskaya “Nursing care for childhood diseases” -2013

2. Rzyankina M.F., Molochny V.G. - “Local pediatrician” - 2005.

3. V.F. Uchaikin, V.P. Molochny “Emergency conditions in pediatrics” -2005

4. Petrushina A.D. "Emergency conditions in children" 2010

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First aid for a child in emergency conditions

Failure to provide assistance or leaving one in danger may result in criminal penalties:

Criminal Code of the Russian Federation, Article 124. Failure to provide assistance to a patient

1. Failure to provide assistance to a patient without good reason by a person obligated to provide it in accordance with the law or with a special rule, if this resulted in negligence in causingmoderate harm health of the patient, is punishable by a fine in the amount of up to forty thousand rubles, or in the amount of the wages or other income of the convicted person for a period of up to three months, or by compulsory labor for a term of up to three hundred sixty hours, or by corrective labor for a term of up to one year, or by arrest for a term of up to four months.

Criminal Code of the Russian Federation, Article 125. Leaving in danger

Known leaving without help a person who is in a condition dangerous to life or health and is deprived of the opportunity to take measures for self-preservation due to childhood, old age, illness or due to his helplessness, in cases where the culprit had the opportunity to help this person and was obliged to take care of him or himself put him in a condition dangerous to life or health, shall be punishable by a fine in the amount of up to eighty thousand rubles, or in the amount of the wages or other income of the convicted person for a period of up to six months, or by compulsory labor for a term of up to three hundred sixty hours, or by corrective labor for a term of up to one year, or forced labor for a term of up to one year, or arrest for a term of up to three months, or imprisonment for a term of up to one year.

FIRST AID

FAINTING.

If a child stays in a stuffy room for a long time, due to strong fear, anxiety, a sudden change in body position, or other situations, the child may lose consciousness.

First aid for fainting

lay down without a pillow
raise your legs a little
unbutton your clothes
open the window
splash your face with cold water
give a cotton swab with ammonia a whiff
During an attack, monitor the child’s pulse, pay attention to its rhythm, and, if possible, measure the pressure. This data will help further determine the cause of fainting.

When the child regains consciousness, it is necessary to let him lie down until he completely feels well and for at least 5-10 minutes, drink strong sweet tea

BRUISED.

Rest and unloading of the injured limb are required. Apply a soft fixing bandage to the damaged joint and an ice pack on the first day. To reduce pain, you need to provide complete rest to the bruised part of the body and give it an elevated position.

BLEEDING.

Temporary methods of stopping bleeding depend on the type, location and intensity of bleeding. Blood may flow out in a stream ( arterial bleeding) or slowly accumulate in the wound ( venous bleeding). Capillary bleeding is associated with damage to smallcirculatory vessels . In this case, the entire wound surface bleeds. Typically, such bleeding is not accompanied by significant blood loss and is easy to stop. When providing first aid, it is enough to treat the wound with iodine tincture and apply a gauze bandage.

Sometimes the bleeding is so severe that you have to resort to applying a tourniquet. Any fabric can be used as a tourniquet. A tourniquet is applied above the wound site. A note with the exact time of application of the tourniquet is placed under the bandage (maximum time 30 minutes in winter, 1 hour in summer). It is impossible to hold the tourniquet for more than the prescribed time, as a sharp circulatory disorder and necrosis of the limb may occur. If the wound is on the neck, face, head and a tourniquet cannot be applied, then you should apply pressure with your palm to the area above the wound and urgently call a doctor.

For nasal If bleeding occurs, the child should be placed in a sitting or semi-sitting position, tilt his head slightly and place a cold compress on the bridge of his nose. You can tightly seal the nasal passages with cotton wool swabs moistened with a solution of hydrogen peroxide.

FOOD POISONING -drink plenty of warm boiled water (before the gag reflex). Put the child to bed.

CARBON MONOXIDE POISONING– access to fresh air.

THERMAL BURN

For any thermal burn: quickly remove clothing soaked in hot liquid. In this case, you should not tear off areas of skin that have stuck to the clothes, but you should carefully cut off the clothes with scissors. A sterile bandage should be applied to the burn site. If you don’t have any at hand, then clean materials at hand will do - a clean handkerchief, bed linen or underwear. If blisters have formed on the injured child’s body, they should never be pierced with a needle or cut off with scissors, as there is a possibility of infection in the wound.

ELECTRIC SHOCK

First aid for an electric shock victimshould always involve releasing it from the action of the current; to do this, turn off the switch (if you know where it is). If it is impossible to remove the current source, then it is necessary to follow precautions: do not touch the exposed parts of the victim’s body, but hold him only by his clothes, after putting on rubber gloves, if any, or dry woolen gloves, wrapping his hands in dry clothes or standing on an insulated object - a board, dry rags or put on rubber shoes; pull the victim away. You can use a dry wooden stick or other non-conductive objects to knock off the exposed wires.

If the victim is unconscious and has no heartbeat, it is necessary to immediately applyartificial respiration and indirect cardiac massage. The simplest and most effective method is artificial respiration through the mouth (mouth to mouth). To do this, the victim is placed on his back on a hard horizontal surface, with his head thrown back. Then the person providing assistance takes a deep breath and exhales through a special system (gauze or handkerchief) into the victim’s mouth. When blowing air into your mouth, you must pinch your nose to ensure a tight seal.

After two breaths, the helper kneels down next to the victim, places his left hand on the bottom of the chest (2 cm above the xiphoid process), the right hand on top in a cross-shaped position, the arms should be straight. The technique of cardiac massage involves rhythmic pressure on the chest to compress the heart muscle. 15 pressing movements are made on the chest without lifting the hands at a speed equal to 1 pressing per second. Pressure on the chest must be done in such a way that it drops a few centimeters.

A cat's eye indicates that a person is dead; dilated pupil - that the person is alive.

At the same time, it is urgent to call a doctor and an ambulance.

During chest compressions, rib fractures may occur.

FRACTURES

Rib fracture - the child takes a forced semi-sitting position, a tight pressure bandage is applied.

When a fracture occurs, a complete or partial disruption of the integrity of the bone occurs. Fractures are divided into open and closed:

At open fracturethe skin is damaged and the bone protrudes from the outside;

At closed fractureno damage to the skin.

Signs of a fracture:

Change in limb length;

Pain in the area of injury;

Bruising in the area of injury;

Swelling;

A crunch is heard;

Previously unusual mobility of the limb (fracture area).

The main actions when providing first aid are to create complete rest and immobility of the victim, prepare for immobilization (creating a fixed bandage);

Fracture of upper/lower limb

Immobility of the bones at the fracture site is achieved by applying special splints. You can use any available materials - sticks, pieces of plywood, strong cardboard, skis, reed stalks, umbrellas, rulers, etc.

Rules for applying splints:

Do not stretch your limbs;

When immobilizing, two nearby joints should be fixed - below and above the fracture (for the upper extremities) and all joints in case of injury to the lower extremities;

Be sure to place cotton wool, rags, clothes (whatever soft is available) under the tire;

The splint is attached to the limb tightly; loose fastening (looseness) is not allowed.

At collarbone fracturea scarf bandage is applied.

In case of a fracture of two collarbones, the “prisoner” pose (hands are tied behind the back).

FOREIGN BODIES

In the eye – do not allow your child to rub the injured eye, do not try to force open the injured eye, wash your hands before providing assistance.

See a doctor if: the eye is damaged or you are unable to remove the foreign body yourself. Gently pull down the lower eyelid and try to see the foreign body. If you see it, remove it with a corner of the cloth. If you do not see a foreign body, examine the upper eyelid. Remove the foreign body with a corner of a cloth or by rinsing the eye with boiled water. If you cannot see the foreign body or it cannot be removed, apply a sterile napkin, then a bandage over both eyes and consult a doctor.

In the nose – ask the child to blow his nose.

In the respiratory tract– throw the child over your knee, tap him on the back, and let him catch his breath.

From all of the above, each group should collect the following minimum set for emergency care:

According to order 302-N “On substances..”, iodine is stored in a dark, cool place (as it is explosive). Potassium permanganate in powder form is classified as a narcotic drug and should not be stored in a preschool educational institution.

In conclusion, I would like to remind you once again that even seemingly minor domestic injuries must be taken seriously and, when providing assistance, certain rules must be followed to prevent various complications. You must always remember that the success of further treatment will depend on timely and correctly provided first aid at the scene of the incident.

Emergency conditions in children in dow. Emergency conditions in children. Rules and principles of first aid for clinical signs of these conditions, nursing measures and criteria for assessing their practical effectiveness. Baby and Carlson

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