home Audience 5 Emergency conditions: causes, symptoms and emergency care. Nurse's first aid schemes for emergencies

Emergency conditions: causes, symptoms and emergency care. Nurse's first aid schemes for emergencies

Fainting is a sudden, short-term loss of consciousness that occurs as a result of impaired blood circulation in the brain.

Fainting can last from a few seconds to several minutes. Usually a person comes to his senses after a while. Fainting in itself is not a disease, but rather a symptom of a disease.

Fainting can be due to various reasons:

1. Unexpected sharp pain, fear, nervous shock.

They can cause an immediate decrease in blood pressure, resulting in a decrease in blood flow, disruption of blood supply to the brain, which leads to fainting.

2. General weakness of the body, sometimes aggravated by nervous exhaustion.

General weakness of the body resulting from the most various reasons From hunger, poor nutrition to constant worry, it can also lead to low blood pressure and fainting.

3. Staying in a room with insufficient oxygen.

Oxygen levels can be reduced due to large numbers of people indoors, poor ventilation, and air pollution from tobacco smoke. As a result, the brain receives less oxygen than needed, and the victim faints.

4. Staying in a standing position for a long time without moving.

This leads to stagnation of blood in the legs, a decrease in its flow to the brain and, as a result, to fainting.

Symptoms and signs of fainting:

Reaction - short-term loss of consciousness, the victim falls. In a horizontal position, blood supply to the brain improves and after some time the victim regains consciousness.

Breathing is rare and shallow. Blood circulation - pulse is weak and rare.

Other signs are dizziness, tinnitus, severe weakness, blurred vision, cold sweat, nausea, numbness of the limbs.

First aid for fainting

1. If the airways are clear, the victim is breathing and his pulse is palpable (weak and rare), he must be placed on his back and his legs raised.

2. Unfasten tight parts of clothing, such as collars and belts.

3. Place a wet towel on the victim's forehead or wet his face with cold water. This will lead to vasoconstriction and improve blood supply to the brain.

4. When vomiting, the victim must be moved to a safe position or at least turned his head to the side so that he does not choke on the vomit.

5 It must be remembered that fainting can be a manifestation of a serious, including acute, illness that requires emergency assistance. Therefore, the victim always needs to be examined by a doctor.

6. You should not rush to raise the victim after he has regained consciousness. If conditions allow, the victim can be given hot tea, and then helped to rise and sit down. If the victim feels faint again, he must be placed on his back and his legs raised.

7. If the victim is unconscious for several minutes, most likely it is not fainting and qualified medical attention is needed.

Shock is a condition that threatens the life of the victim and is characterized by insufficient blood supply to tissues and internal organs.

The blood supply to tissues and internal organs can be impaired for two reasons:

Heart problems;

Reducing the volume of fluid circulating in the body (severe bleeding, vomiting, diarrhea, etc.).

Symptoms and signs of shock:

Reaction - the victim is usually conscious. However, the condition can worsen very quickly, even to the point of loss of consciousness. This is due to a decrease in blood supply to the brain.

The airways are usually free. If there internal bleeding, there may be problems.

Breathing is frequent and shallow. This breathing is explained by the fact that the body is trying to get as much oxygen as possible with a limited blood volume.

Blood circulation - pulse is weak and frequent. The heart tries to compensate for the decrease in circulating blood volume by speeding up blood circulation. Decreased blood volume leads to a fall blood pressure.

Other signs are skin that is pale, especially around the lips and earlobes, and cool and clammy. This is because the blood vessels in the skin close to direct blood to vital organs such as the brain, kidneys, etc. Sweat glands also enhance activity. The victim may feel thirsty due to the fact that the brain senses a lack of fluid. Muscle weakness occurs due to the fact that blood from the muscles goes to the internal organs. There may be nausea, vomiting, chills. Chills mean lack of oxygen.

First aid for shock

1. If the shock is caused by a circulatory disorder, then first of all you need to take care of the brain - ensure the supply of oxygen to it. To do this, if the injury allows, the victim must be laid on his back, his legs raised and the bleeding stopped as quickly as possible.

If the victim has a head injury, then the legs cannot be raised.

The victim must be placed on his back with something under his head.

2. If shock is caused by burns, then first of all it is necessary to ensure that the effect of the damaging factor ceases.

Then cool the affected area of the body, if necessary, lay the victim with his legs elevated and cover him with something to keep warm.

3. If shock is caused by cardiac dysfunction, the victim must be placed in a semi-sitting position, placing pillows or folded clothing under the head and shoulders, as well as under the knees.

It is not advisable to lay the victim on his back, as this will make it more difficult for him to breathe. Give the victim an aspirin tablet to chew.

In all of the above cases, it is necessary to call an ambulance and, until it arrives, monitor the condition of the victim, being ready to begin cardiopulmonary resuscitation.

When providing assistance to a victim in shock, it is unacceptable:

Move the victim, except when necessary;

Allow the victim to eat, drink, smoke;

Leave the victim alone, except in cases where it is necessary to leave to call an ambulance;

Warm the victim with a heating pad or some other heat source.

ANAPHYLACTIC SHOCK

Anaphylactic shock is an immediate widespread allergic reaction that occurs when an allergen enters the body (insect bites, medicinal or food allergens).

Anaphylactic shock usually develops within a few seconds and is an emergency that requires immediate attention.

If anaphylactic shock is accompanied by loss of consciousness, immediate hospitalization is necessary, since the victim in this case may die within 5-30 minutes due to asphyxia or after 24-48 hours or more due to severe irreversible changes in life important organs.

Sometimes death can occur later due to changes in the kidneys, gastrointestinal tract, heart, brain and other organs.

Symptoms and signs of anaphylactic shock:

Reaction - the victim feels anxiety, a sense of fear, and as shock develops, loss of consciousness is possible.

Airways - swelling of the airways occurs.

Breathing - similar to asthmatic. Shortness of breath, a feeling of tightness in the chest, coughing, intermittent, difficult, may stop completely.

Blood circulation - the pulse is weak, rapid, and may not be palpable on the radial artery.

Other signs are a tense chest, swelling of the face and neck, swelling around the eyes, redness of the skin, rash, red spots on the face.

First aid for anaphylactic shock

1. If the victim is conscious, give him a semi-sitting position to facilitate breathing. It is better to sit him on the floor, unbutton the collar and loosen other pressing parts of the clothing.

2. Call an ambulance.

3. If the victim is unconscious, move him to a safe position, control breathing and blood circulation and be ready to begin cardiopulmonary resuscitation.

ATTACK OF BRONCHIAL ASTHMA

Bronchial asthma is an allergic disease, the main manifestation of which is an attack of suffocation caused by obstruction of the bronchial tubes.

An attack of bronchial asthma is caused by various allergens (pollen and other substances of plant and animal origin, industrial products, etc.)

Bronchial asthma is expressed in attacks of suffocation, experienced as a painful lack of air, although in reality it is based on difficulty in exhaling. The reason for this is the inflammatory narrowing of the airways caused by allergens.

Symptoms and signs of bronchial asthma:

Reaction - the victim may be alarmed, during severe attacks he may not be able to utter several words in a row, and he may lose consciousness.

Airways may be narrowed.

Breathing - characterized by difficult, prolonged exhalation with a lot of wheezing, often heard at a distance. Shortness of breath, cough, dry at first, and at the end with viscous sputum.

Blood circulation - at first the pulse is normal, then it becomes rapid. At the end of a prolonged attack, the pulse may become thread-like until the heart stops.

Other signs are anxiety, extreme fatigue, sweating, tension in the chest, speaking in a whisper, bluish skin, nasolabial triangle.

First aid for an attack of bronchial asthma

1. Bring the victim to Fresh air, unfasten the collar and loosen the belt. Sit leaning forward and focusing on your chest. In this position, the airways open.

2. If the victim has any medications, help them use them.

3. Call an ambulance immediately if:

This is the first attack;

The attack did not stop after taking the medicine;

The victim has difficulty breathing and finds it difficult to speak;

The victim showed signs of extreme exhaustion.

HYPERVENTILATION

Hyperventilation is pulmonary ventilation that is excessive in relation to the level of metabolism, caused by deep and (or) frequent breathing and leading to a decrease in carbon dioxide and an increase in oxygen in the blood.

The cause of hyperventilation is most often panic or serious anxiety caused by fright or some other reason.

Feeling extreme anxiety or panic, a person begins to breathe more quickly, which leads to a sharp decrease in carbon dioxide levels in the blood. Hyperventilation sets in. As a result, the victim begins to feel even more anxious, which leads to increased hyperventilation.

Symptoms and signs of hyperventilation:

Reaction - the victim is usually alarmed and feels confused. The airways are open and free.

Breathing is naturally deep and frequent. As hyperventilation develops, the victim breathes more and more frequently, but subjectively feels suffocated.

Blood circulation - does not help to recognize the cause.

Other signs include the victim feeling dizzy, a sore throat, tingling in the arms, legs or mouth, and the heart rate may increase. Seeks attention, help, may become hysterical, faint.

First aid for hyperventilation.

1. Bring a paper bag to the victim's nose and mouth and ask him to breathe the air that he exhales into the bag. In this case, the victim exhales air saturated with carbon dioxide into the bag and inhales it again.

Typically, after 3-5 minutes, the level of blood carbon dioxide saturation returns to normal. The respiratory center in the brain receives the appropriate information about this and sends a signal: breathe more slowly and deeply. Soon the muscles of the respiratory organs relax, and the entire respiratory process comes back to normal.

2. If the cause of hyperventilation is emotional arousal, it is necessary to calm the victim, restore his sense of confidence, and persuade the victim to sit calmly and relax.

ANGINA

Angina pectoris (angina pectoris) - attack acute pain behind the sternum, caused by transient coronary circulatory failure, acute myocardial ischemia.

The cause of an attack of angina is insufficient blood supply to the heart muscle, caused by coronary insufficiency due to a narrowing of the lumen of the coronary artery of the heart due to atherosclerosis, vascular spasm, or a combination of these factors.

Angina pectoris can occur as a result of psycho-emotional stress, which can lead to spasm of the pathologically unchanged coronary arteries of the heart.

However, most often angina still occurs when the coronary arteries are narrowed, which can account for 50–70% of the lumen of the vessel.

Symptoms and signs of angina:

Reaction - the victim is conscious.

The airways are clear.

Breathing is shallow, the victim does not have enough air.

Blood circulation - pulse is weak and frequent.

Other signs - the main sign of pain syndrome is its paroxysmal nature. The pain has a fairly clear beginning and end. The nature of the pain is squeezing, pressing, sometimes in the form of a burning sensation. As a rule, it is localized behind the sternum. Irradiation of pain to the left half of the chest is characteristic, in left hand to the fingers, left shoulder blade and shoulder, neck, lower jaw.

The duration of pain during angina pectoris, as a rule, does not exceed 10-15 minutes. They usually occur during physical activity, most often when walking, and also during stress.

First aid for angina pectoris.

1. If an attack develops during physical activity, it is necessary to stop the exercise, for example, stop.

2. Place the victim in a semi-sitting position, placing pillows or folded clothing under his head and shoulders, as well as under his knees.

3. If the victim has previously had angina attacks for which he used nitroglycerin, he can take it. For faster absorption, a nitroglycerin tablet must be placed under the tongue.

The victim should be warned that after taking nitroglycerin, a feeling of fullness in the head and headache, sometimes - dizziness, and, if standing, fainting. Therefore, the victim must remain in a semi-sitting position for some time even after the pain will go away.

If nitroglycerin is effective, the angina attack goes away within 2–3 minutes.

If the pain does not disappear a few minutes after taking the drug, you can take it again.

If, after taking the third tablet, the victim’s pain does not go away and lasts for more than 10–20 minutes, it is necessary to urgently call an ambulance, since there is a possibility of developing a heart attack.

HEART ATTACK (MYOCARDIAL INFARCTION)

Heart attack (myocardial infarction) is necrosis (death) of a section of the heart muscle due to disruption of its blood supply, which manifests itself in impaired cardiac activity.

A heart attack occurs due to a blockage coronary artery thrombus - a blood clot that forms at the site of narrowing of a vessel due to atherosclerosis. As a result, a more or less extensive area of the heart is “switched off”, depending on which part of the myocardium the blocked vessel supplied with blood. The blood clot stops the supply of oxygen to the heart muscle, resulting in necrosis.

The causes of a heart attack can be:

Atherosclerosis;

Hypertonic disease;

Physical activity combined with emotional stress - vasospasm during stress;

Diabetes and other metabolic diseases;

Genetic predisposition;

Environmental influence, etc.

Symptoms and signs heart attack(heart attack):

Reaction - in the initial period of a painful attack, restless behavior, often accompanied by fear of death, later loss of consciousness is possible.

The airways are usually free.

Breathing is frequent, shallow, and may stop. In some cases, attacks of suffocation are observed.

Blood circulation - pulse is weak, fast, and may be intermittent. Possible cardiac arrest.

Other signs are severe pain in the heart area, usually occurring suddenly, often behind the sternum or to the left of it. The nature of the pain is squeezing, pressing, burning. It usually radiates to the left shoulder, arm, and shoulder blade. Often during a heart attack, unlike angina pectoris, the pain spreads to the right of the sternum, sometimes involving the epigastric region and “radiates” to both shoulder blades. The pain is growing. The duration of a painful attack during a heart attack is calculated in tens of minutes, hours, and sometimes days. There may be nausea and vomiting, the face and lips may turn blue, and severe sweating. The victim may lose the ability to speak.

First aid for a heart attack.

1. If the victim is conscious, give him a semi-sitting position, placing pillows or folded clothes under his head and shoulders, as well as under his knees.

2. Give the victim an aspirin tablet and ask him to chew it.

3. Loosen tight parts of clothing, especially around the neck.

4. Call an ambulance immediately.

5. If the victim is unconscious but breathing, place him in a safe position.

6. Monitor breathing and blood circulation; in case of cardiac arrest, immediately begin cardiopulmonary resuscitation.

Stroke is an acute circulatory disorder caused by a pathological process in the brain or spinal cord with the development of persistent symptoms of damage to the central nervous system.

The cause of a stroke may be a cerebral hemorrhage, cessation or weakening of the blood supply to any part of the brain, blockage of a vessel by a thrombus or embolus (a thrombus is a dense clot of blood in the lumen of a blood vessel or heart cavity, formed during life; an embolus is a substrate circulating in the blood, not occurs under normal conditions and can cause blockage of blood vessels).

Strokes are more common in older people, although they can occur at any age. More often observed in men than in women. About 50% of stroke victims die. Of those who survive, approximately 50% are crippled and have another stroke weeks, months or years later. However, many stroke survivors regain their health with the help of rehabilitation measures.

Symptoms and signs of stroke:

Reaction - consciousness is confused, there may be loss of consciousness.

The airways are clear.

Breathing - slow, deep, noisy, wheezing.

Blood circulation - pulse is rare, strong, with good filling.

Other signs are a severe headache, the face may turn red, become dry, hot, disturbances or slowing of speech may be observed, and the corner of the lips may sag even if the victim is conscious. The pupil on the affected side may be dilated.

With a minor lesion there is weakness, with a significant one - complete paralysis.

First aid for stroke

1. Call qualified medical assistance immediately.

2. If the victim is unconscious, check whether the airway is open, and restore airway patency if it is compromised. If the victim is unconscious but breathing, move him to a safe position on the side of the injury (to the side where the pupil is dilated). In this case, the weakened or paralyzed part of the body will remain at the top.

3. Be prepared for rapid deterioration of the condition and for cardiopulmonary resuscitation.

4. If the victim is conscious, place him on his back with something under his head.

5. The victim may have a mini-stroke, in which there is a slight speech disorder, slight clouding of consciousness, slight dizziness, and muscle weakness.

In this case, when providing first aid, you should try to protect the victim from falling, calm and support him, and immediately call an ambulance. Control DP - D - K and be ready to provide emergency assistance.

EPILEPTIC ATTACK

Epilepsy is a chronic disease caused by brain damage, manifested by repeated convulsive or other seizures and accompanied by a variety of personality changes.

An epileptic seizure is caused by excessively intense stimulation of the brain, which is caused by an imbalance in the human bioelectric system. Typically, a group of cells in one part of the brain becomes electrically unstable. This creates a strong electrical discharge that rapidly spreads to surrounding cells, disrupting their normal functioning.

Electrical phenomena can affect the entire brain or just part of it. Accordingly, major and minor epileptic seizures are distinguished.

A minor epileptic seizure is a short-term disruption of brain activity, leading to temporary loss of consciousness.

Symptoms and signs of petit mal seizure:

Reaction - temporary loss of consciousness (from several seconds to a minute). The airways are open.

Breathing is normal.

Blood circulation - pulse is normal.

Other signs are a blank gaze, repeated or twitching movements of individual muscles (head, lips, arms, etc.).

A person comes out of such a seizure as suddenly as he entered it, and he continues the interrupted actions, not realizing that a seizure was happening to him.

First aid for petit mal seizure

1. Eliminate the danger, sit the victim down and calm him down.

2. When the victim wakes up, tell him about the seizure, since this may be his first seizure and the victim does not know about the illness.

3. If this is the first seizure, consult a doctor.

Grand mal seizure is sudden loss consciousness, accompanied by severe spasms (convulsions) of the body and limbs.

Symptoms and signs of grand mal seizure:

Reaction - begins with sensations close to euphoric (unusual taste, smell, sound), then loss of consciousness.

The airways are clear.

Breathing may stop, but is quickly restored. Blood circulation - pulse is normal.

Other signs are that the victim usually falls to the floor unconscious, and begins to experience sudden convulsive movements of the head, arms and legs. There may be a loss of control over physiological functions. The tongue is bitten, the face turns pale, then becomes cyanotic. The pupils do not react to light. Foam may appear at the mouth. Total duration the seizure ranges from 20 seconds to 2 minutes.

First aid for grand mal seizure

1. If you notice that someone is on the verge of a seizure, you need to try to ensure that the victim does not hurt himself if he falls.

2. Make room around the victim and place something soft under his head.

3. Unbutton the clothing around the victim's neck and chest.

4. Do not attempt to restrain the victim. If his teeth are clenched, do not try to unclench his jaws. Do not try to put anything into the victim’s mouth, as this can lead to injury to the teeth and closure of the respiratory tract with fragments.

5. After the convulsions have stopped, move the victim to a safe position.

6. Treat any injuries sustained by the victim during the seizure.

7. After the seizure has stopped, the victim must be hospitalized if:

The seizure happened for the first time;

There was a series of seizures;

There is damage;

The victim was unconscious for more than 10 minutes.

HYPOGLYCEMIA

Hypoglycemia - low blood glucose levels Hypoglycemia can occur in a diabetic patient.

Diabetes is a disease in which the body does not produce enough of the hormone insulin, which regulates the amount of sugar in the blood.

If the brain does not receive enough sugar, then just like with a lack of oxygen, brain functions are impaired.

Hypoglycemia can occur in a diabetic patient for three reasons:

1) the victim injected insulin, but did not eat on time;

2) with excessive or prolonged physical activity;

3) in case of insulin overdose.

Symptoms and signs of hypoglycemia:

Reaction: consciousness is confused, loss of consciousness is possible.

The airways are clean and free. Breathing is rapid, shallow. Blood circulation - rare pulse.

Other signs are weakness, drowsiness, dizziness. Feelings of hunger, fear, pale skin, profuse sweat. Visual and auditory hallucinations, muscle tension, trembling, convulsions.

First aid for hypoglycemia

1. If the victim is conscious, give him a relaxed position (lying or sitting).

2. Give the victim a sugar drink (two tablespoons of sugar per glass of water), a piece of sugar, chocolate or candy, maybe caramel or cookies. Sweetener doesn't help.

3. Ensure rest until the condition is completely normalized.

4. If the victim loses consciousness, transfer him to a safe position, call an ambulance and monitor his condition, and be ready to begin cardiopulmonary resuscitation.

POISONING

Poisoning is intoxication of the body caused by the action of substances entering it from the outside.

Toxic substances can enter the body in various ways. There are different classifications of poisoning. For example, poisoning can be classified according to the conditions under which toxic substances enter the body:

During meals;

Through the respiratory tract;

Through the skin;

When bitten by an animal, insect, snake, etc.;

Through mucous membranes.

Poisoning can be classified according to the type of poisoning:

Food poisoning;

Drug poisoning;

Alcohol poisoning;

Chemical poisoning;

Gas poisoning;

Poisoning caused by insect, snake, and animal bites.

The task of first aid is to prevent further exposure to poison, to accelerate its elimination from the body, to neutralize the remains of poison and to support the activity of affected organs and systems of the body.

To solve this problem you need:

1. Take care of yourself so as not to get poisoned, otherwise you will need help yourself, and the victim will have no one to help.

2. Check the victim's reaction, airway, breathing and blood circulation, and take appropriate measures if necessary.

5. Call an ambulance.

4. If possible, determine the type of poison. If the victim is conscious, ask him about what happened. If unconscious, try to find witnesses to the incident, or packaging of toxic substances or some other signs.

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

Types of medical care

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

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

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

Emergency and urgent care

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

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

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

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

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

Emergency care must be provided in any medical institution.

First aid in emergency situations is very important.

Major emergencies

Emergency conditions can be divided into several groups:

Injuries. These include:

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

2. Poisoning. Damage occurs inside the body, unlike injury, it is the result external influence. Disruption of the functioning of internal organs in case of untimely emergency care can lead to death.

Poison can enter the body:

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

Treatment emergencies include:

1. Acute conditions internal organs:

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

2. Anaphylactic shock.

3. Hypertensive crises.

4. Attacks of suffocation.

5. Hyperglycemia in diabetes mellitus.

Emergency conditions in pediatrics

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

Pediatric emergencies that require medical attention:

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

In these cases, emergency medical services are called.

Features of providing emergency care to a child

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

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

The doctor should ask the following questions:

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

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

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

At the first stage, the doctor must:

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

It is necessary to pay attention to the following points:

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

Emergency conditions in therapy and assistance

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

Emergency conditions in therapy include:

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

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

The assistance provided is as follows:

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

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

Providing assistance is as follows:

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

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

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

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

Emergency assistance is as follows:

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

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

4. Coma. May be of different types.

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

Urgent Care:

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

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

Emergency assistance includes:

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

5. Acute allergic diseases. TO serious illnesses may include: bronchial asthma and angioedema. Anaphylactic shock. Symptoms: the appearance of skin itching, excitability, increased blood pressure, feeling of heat. Then loss of consciousness and respiratory arrest, heart rhythm failure are possible.

Emergency assistance is as follows:

Place the patient so that the head is lower than the level of the legs.
Provide air access.
Clear the airways, turn your head to the side, and extend your lower jaw.
Introduce "Adrenaline", repeated administration is allowed after 15 minutes.
"Prednisolone" IV.
Antihistamines.
For bronchospasm, a solution of "Eufillin" is administered.
Urgent hospitalization.

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

We provide emergency assistance.

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

Let us pay attention to emergency conditions in gynecology:

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

Let's consider providing emergency care for ovarian apoplexy:

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

It is necessary to monitor indicators:

Blood pressure.
Heart rate.
Body temperature.
Frequency breathing movements.
Pulse.

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

How are emergencies diagnosed?

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

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

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

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

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

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

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

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

Emergency care algorithm

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

The operating principle is as follows:

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

What to do before the doctor arrives

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

Algorithm of actions:

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

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

2. Heart massage. The victim is in a supine position. We stand on the side and place our palm on top of our chest at a distance of 2-3 fingers above the lower edge of the chest. Then we apply pressure so that the chest moves by 4-5 cm. Within a minute, you need to do 60-80 pressures.

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

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

Help with bleeding:

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

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

Providing first aid for fractures and dislocations.

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

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

What should be in a medical kit

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

An emergency first aid kit must meet the following requirements:

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

What should be in the first aid kit:

Preparations for treating wounds, antiseptics:

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

2. Sterile or simple gauze mask.

3. Sterile and non-sterile rubber gloves.

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

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

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

7. Heart medications: Corvalol, Validol, Nitroglycerin.

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

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

10. Ammonia.

11. Medical instruments:

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

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

13. Antidotes.

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

Introduction

The purpose of this essay is to study the basic concepts regarding the provision of first aid, as well as to consider a set of measures for the provision of first aid.
The subject of the study is emergency conditions, accidents, and shock.

Emergency condition

Emergency conditions are a set of symptoms (clinical signs) requiring first aid, emergency medical care, or hospitalization of the victim or patient. Not all conditions are immediately life-threatening, but they do require care to prevent significant and long-term effects on the physical or mental health of the person with the condition.

TYPES OF EMERGENCIES:

ANAPHYLACTIC SHOCK

ATTACK OF BRONCHIAL ASTHMA

HYPERVENTILATION

ANGINA

EPILEPTIC ATTACK

HYPOGLYCEMIA

POISONING

A feature of emergency conditions is the need for accurate diagnosis in the shortest possible time and, based on the expected diagnosis, the determination of treatment tactics. These conditions can arise as a result of acute diseases and injuries of the digestive organs, exacerbation of chronic diseases, or as a result of complications.

The urgency of the condition is determined by:
Firstly, the degree and speed of dysfunction of vital organs and systems, primarily:
hemodynamic disturbances (sudden change in frequency, pulse rhythm, rapid decrease or increase in blood pressure, acute development heart failure, etc.);
dysfunction of the central nervous system (violation of the psycho-emotional sphere, convulsions, delirium, unconsciousness, cerebrovascular accident, etc.);
respiratory dysfunction (acute change in frequency, breathing rhythm, asphyxia, etc.);

Secondly,
the outcome of an emergency condition or disease (“to foresee a danger means to half avoid it”). For example, a rise in blood pressure (especially against the background of its persistent increase) is a threat of stroke; infectious hepatitis - acute yellow liver degeneration, etc.;

Thirdly, extreme anxiety and behavior of the patient:
directly life-threatening pathological conditions;
pathological conditions or diseases that are not directly life-threatening, but in which such a threat can become real at any time;
conditions in which the lack of modern medical care can lead to permanent changes in the body;
conditions in which the shortest possible time it is necessary to alleviate the suffering of the patient;
conditions requiring urgent medical intervention in the interests of others due to the patient’s behavior.

First aid for emergencies

Fainting is a sudden, short-term loss of consciousness that occurs as a result of impaired blood circulation in the brain.

Fainting can last from a few seconds to several minutes. Usually a person comes to his senses after a while. Fainting in itself is not a disease, but rather a symptom of a disease.

First aid for fainting

1. If the airways are clear, the victim is breathing and his pulse is palpable (weak and rare), he must be laid on his back and his legs raised.

2. Unfasten tight parts of clothing, such as collars and belts.

3. Place a wet towel on the victim’s forehead, or wet his face with cold water. This will lead to vasoconstriction and improve blood supply to the brain.

4. If vomiting, the victim must be moved to a safe position or at least turned his head to the side so that he does not choke on the vomit.

5 It must be remembered that fainting can be a manifestation of a serious, including acute, illness that requires emergency care. Therefore, the victim always needs to be examined by a doctor.

7. If the victim is unconscious for several minutes, most likely it is not fainting and qualified medical assistance is needed.

ATTACK OF BRONCHIAL ASTHMA

Bronchial asthma is an allergic disease, the main manifestation of which is an attack of suffocation caused by obstruction of the bronchial tubes.

First aid for an attack of bronchial asthma

1. Take the victim out into the fresh air, unfasten the collar and loosen the belt. Sit leaning forward and focusing on your chest. In this position, the airways open.

2. If the victim has any medications, help use them.

3. Call an ambulance immediately if:

This is the first attack;

The attack did not stop after taking the medicine;

The victim has difficulty breathing and finds it difficult to speak;

The victim showed signs of extreme exhaustion.

HYPERVENTILATION

First aid for hyperventilation.

1. Bring a paper bag to the victim’s nose and mouth and ask him to breathe the air that he exhales into this bag. In this case, the victim exhales air saturated with carbon dioxide into the bag and inhales it again.

2. If the cause of hyperventilation was emotional excitement, it is necessary to calm the victim, restore his sense of confidence, and persuade the victim to sit calmly and relax.

ANGINA

Angina pectoris (angina pectoris) is an attack of acute pain in the chest caused by transient coronary circulatory failure and acute myocardial ischemia.

First aid for angina pectoris.

1. If an attack develops during physical activity, it is necessary to stop the exercise, for example, stop.

2. Give the victim a semi-sitting position, placing pillows or folded clothes under his head and shoulders, as well as under his knees.

3. If the victim has previously had angina attacks, for the relief of which he used nitroglycerin, he can take it. For faster absorption, a nitroglycerin tablet must be placed under the tongue.

The victim should be warned that after taking nitroglycerin, a feeling of fullness in the head and headache, sometimes dizziness, and, if standing, fainting may occur. Therefore, the victim should remain in a semi-sitting position for some time even after the pain goes away.

If nitroglycerin is effective, the angina attack goes away within 2–3 minutes.

If the pain does not disappear a few minutes after taking the drug, you can take it again.

HEART ATTACK (MYOCARDIAL INFARCTION)

Heart attack (myocardial infarction) is necrosis (death) of a section of the heart muscle due to disruption of its blood supply, which manifests itself in impaired cardiac activity.

First aid for a heart attack.

1. If the victim is conscious, give him a semi-sitting position, placing pillows or folded clothes under his head and shoulders, as well as under his knees.

2. Give the victim an aspirin tablet and ask him to chew it.

3. Loosen tight parts of clothing, especially around the neck.

4. Call an ambulance immediately.

5. If the victim is unconscious but breathing, place him in a safe position.

6. Monitor breathing and blood circulation; in case of cardiac arrest, immediately begin cardiopulmonary resuscitation.

Stroke is an acute disturbance of blood circulation in the brain or spinal cord caused by a pathological process with the development of persistent symptoms of damage to the central nervous system.

First aid for stroke

1. Immediately call qualified medical assistance.

2. If the victim is unconscious, check whether the airways are open, and restore airway patency if it is compromised. If the victim is unconscious but breathing, move him to a safe position on the side of the injury (to the side where the pupil is dilated). In this case, the weakened or paralyzed part of the body will remain at the top.

3. Be prepared for rapid deterioration of the condition and for cardiopulmonary resuscitation.

4. If the victim is conscious, lay him on his back, placing something under his head.

5. The victim may have a mini-stroke, in which there is a slight speech disorder, slight clouding of consciousness, slight dizziness, and muscle weakness.

In this case, when providing first aid, you should try to protect the victim from falling, calm and support him, and immediately call an ambulance. Monitor DP - D - K and be ready to provide emergency assistance.

EPILEPTIC ATTACK

Epilepsy is a chronic disease caused by brain damage, manifested by repeated convulsive or other seizures and accompanied by a variety of personality changes.

First aid for petit mal seizure

1. Eliminate the danger, sit the victim down and calm him down.

2. When the victim wakes up, tell him about the seizure, since this may be his first seizure and the victim does not know about the illness.

3. If this is the first seizure, consult a doctor.

A grand mal seizure is a sudden loss of consciousness accompanied by severe spasms (convulsions) of the body and limbs.

First aid for grand mal seizure

1. If you notice that someone is on the verge of a seizure, you need to try to ensure that the victim does not hurt himself if he falls.

2. Clear some space around the victim and place something soft under his head.

3. Unfasten the clothes around the victim’s neck and chest.

4. Do not try to restrain the victim. If his teeth are clenched, do not try to unclench his jaws. Do not try to put anything into the victim’s mouth, as this can lead to injury to the teeth and closure of the respiratory tract with fragments.

5. After the convulsions have stopped, transfer the victim to a safe position.

6. Treat all injuries received by the victim during a seizure.

7. After the seizure has stopped, the victim must be hospitalized in cases where:

The seizure happened for the first time;

There was a series of seizures;

There is damage;

The victim was unconscious for more than 10 minutes.

HYPOGLYCEMIA

Hypoglycemia - low blood glucose levels Hypoglycemia can occur in a diabetic patient.

Diabetes is a disease in which the body does not produce enough of the hormone insulin, which regulates the amount of sugar in the blood.

Reaction: consciousness is confused, loss of consciousness is possible.

The airways are clean and free. Breathing is rapid, shallow. Blood circulation - rare pulse.

Other signs are weakness, drowsiness, dizziness. Feelings of hunger, fear, pale skin, profuse sweat. Visual and auditory hallucinations, muscle tension, trembling, convulsions.

First aid for hypoglycemia

1. If the victim is conscious, give him a relaxed position (lying or sitting).

2. Give the victim a sugar drink (two tablespoons of sugar per glass of water), a piece of sugar, chocolate or candy, maybe caramel or cookies. Sweetener doesn't help.

3. Provide rest until the condition is completely normalized.

4. If the victim has lost consciousness, transfer him to a safe position, call an ambulance and monitor the condition, and be ready to begin cardiopulmonary resuscitation.

POISONING

Poisoning is intoxication of the body caused by the action of substances entering it from the outside.

To solve this problem you need:

1. Take care of yourself so as not to get poisoned, otherwise you will need help yourself, and the victim will have no one to help.

2. Check the victim’s reaction, airways, breathing and blood circulation, and take appropriate measures if necessary.

5. Call an ambulance.

Accidents

An accident is an unforeseen event, an unexpected set of circumstances, resulting in bodily injury or death.

Typical examples are a car accident (or being hit by a car), falling from a height, objects falling into windpipe, falling objects (bricks, icicles) on the head, electric shock. Risk factors may include non-compliance with safety precautions and alcohol consumption.

Accident at work - case traumatic injury health of the victim, which occurred for a reason related to his work activity or during work.

TYPES OF ACCIDENTS:

Car accident
Getting hit by a car
Fire
Burning out
Drowning
Falling out of the blue
Falling from height
Falling into a hole
Electric shock
Careless handling of a power saw
Careless handling of explosive materials
Work injuries
Poisoning

Related information.

L E C T I O N

FIRST CARE IN EMERGENCIES

CONDITIONS.

First medical aid is a set of emergency medical measures carried out to a suddenly ill or injured person at the scene of an incident and during his delivery to a medical facility. People who have had an accident or suddenly developed a serious, life-threatening illness need first aid.

Accident is called damage to human organs or disruption of their function due to sudden exposure to the environment. Accidents often occur in conditions where it is not possible to quickly report them to an emergency medical service station. In such a situation it is extremely important acquires first aid, which must be provided at the scene of the incident before the arrival of a doctor or delivery of the victim to a medical facility. In case of accidents, victims often seek help from the nearest medical facility, including a pharmacy. The pharmacist must be able to provide emergency first aid, know the main signs of various injuries, sudden illnesses, and clearly understand how dangerous these injuries or conditions can be for the victim.

^ First aid includes the following three groups of measures:

1. Immediate cessation of exposure to external damaging factors and removal of the victim from the unfavorable conditions in which he finds himself.

2. Providing first aid to the victim, depending on the nature and type of injury, accident or sudden illness.

3. Organization of the prompt delivery (transportation) of a sick or injured person to a medical institution.

Meaning first aid difficult to overestimate. Timely and correctly performed medical care sometimes not only saves the victim’s life, but also ensures further successful treatment of the disease or injury, prevents the development of severe complications (shock, wound suppuration), general blood poisoning, and reduces disability.

An injured or suddenly ill person can contact the pharmacy at any time. Therefore, at the workplace it is necessary to have a set of equipment and medicines to provide first aid. The first aid kit should contain: hydrogen peroxide solution, alcohol solution iodine, ammonia, analgesics, cardiovascular drugs, antipyretic, antimicrobial, laxatives, hemostatic tourniquet, thermometer, individual dressing bag, sterile bandages, cotton wool, splints.

In recent decades, the medical discipline has developed and achieved significant success. resuscitation - science about the mechanism of development and methods of treating terminal conditions bordering on biological death. The successes of resuscitation have direct access to practical medicine and form the basis resuscitation (revival), which represents a system of measures aimed at restoring the vital functions of the body and removing it from a terminal state. These measures primarily ensure effective breathing and blood circulation.

Terminal states include preagony, agony and clinical death. Pre-agonal They call the period preceding the development of agony, with the patient’s extremely serious condition, severe disruption of breathing, blood circulation and other vital functions of the body. Duration of the preagonal period and features clinical picture largely depend on the nature of the underlying disease that led to the development of the pregonal state. Thus, preagonia can last several hours with increasing respiratory failure and be practically absent with sudden “cardiac” death.

Agonal the period is characterized by the absence of perceptible pulsation large arteries, complete lack of consciousness, severe respiratory distress with rare deep breaths with the participation of auxiliary muscles and facial muscles (characteristic death grimace), severe cyanosis of the skin.

Clinical death is the short period that occurs after the cessation of effective blood circulation and respiration, but before the development of irreversible necrotic (necrobiotic) changes in the cells of the central nervous system and other organs. During this period, provided that sufficient blood circulation and breathing are maintained, restoration of the body’s vital functions is fundamentally achievable.

Signs of clinical death serve: complete absence of consciousness and reflexes (including corneal); sharp cyanosis of the skin and visible mucous membranes (or in some types of dying, for example, with bleeding and hemorrhagic shock, sharp pallor of the skin); significant dilation of the pupils; lack of effective heart contractions and breathing. Cessation of cardiac activity is diagnosed by the absence of pulsation in the carotid arteries and auscultated heart sounds. Electrocardiographically, in patients on a cardiac monitor during this period, ventricular fibrillation is usually detected, i.e. electrocardiographic manifestation of contractions of individual muscle bundles of the myocardium, or a sharp (terminal) bradyarrhythmia with gross deformation of the ventricular complexes, or a straight line is recorded, indicating complete asystole.

The lack of effective breathing is diagnosed simply: if within 10-15 seconds of observation it is not possible to determine obvious and coordinated respiratory movements, spontaneous breathing should be considered absent.

The duration of the clinical death state ranges from 4-6 minutes. It depends on the nature of the underlying disease that led to clinical death, the duration of the previous pre- and agonal periods, because already in these stages of the terminal state, necrobiotic changes develop at the level of cells and tissues. It is not always possible to determine the moment of clinical death. Practice shows that only in 10-15% of cases a medical worker at the prehospital stage can accurately determine the time of clinical death and its transition to biological death. Therefore, in the absence obvious signs biological death in a patient (cadaveric spots, etc.), he should be considered to be in a state of clinical death. In such cases, resuscitation measures must be started immediately. The lack of effect in the first minutes is one of the indicators of the possible occurrence of biological death.

The basis of all resuscitation measures is knowledge of the pathophysiology of dying, a clear understanding of the relative gradualness of the onset of biological death, the presence of a short period of time during which, while maintaining adequate (corresponding to the needs of the body) blood circulation and breathing, restoration of the body’s vital functions is possible.

It is necessary to begin the entire complex of resuscitation measures as early as possible, preferably before complete respiratory arrest and the development of functional cardiac asystole. In this case, there is a much greater chance of an immediate effect of resuscitation and a favorable prognosis for the future. In clinical practice, there are cases of successful restoration of cardiac activity and spontaneous breathing in people who were in a state of clinical death for 6-8 minutes. However, most of these patients died 2-5 days after resuscitation, and those who survived for longer periods showed severe neurological and mental disorders, turning them into severely disabled people. All resuscitation measures are aimed at removing the patient from the terminal state and restoring impaired vital functions. The choice of method and tactics of resuscitation are determined by the mechanism of death and often do not depend on the nature of the underlying disease.

IN last years the term “ intensive therapy". This concept includes the provision of medical care, including emergency care, to patients in serious, often critical, condition. Target intensive care- restoration of circulatory, respiratory, and metabolic disorders that have developed in the patient. Thus, patients with acute heart failure, pulmonary edema, asthmatic status, coma, etc. are subject to intensive care. Successful implementation Intensive therapy prevents in some cases the development of a terminal condition and clinical death in the patient.

^ Basic resuscitation measures are cardiac massage, artificial ventilation, electrical defibrillation and electrical stimulation of the heart, etc.

The main ones in pre-hospital resuscitation, especially when carried out in an out-of-hospital setting, are closed cardiac massage and artificial ventilation. Both measures are carried out immediately and simultaneously when it is determined that the patient or victim has no breathing, no cardiac activity and no signs of biological death. Carrying out the complex resuscitation care the patient usually requires the simultaneous participation of 2-3 people who are well aware of the basics and master the technique of resuscitation. Long-term world practice teaches that the outcome of resuscitation and the further fate of the victim often depend on the correctness of the initial techniques. Therefore, although many resuscitation efforts require medical participation, the need for immediate decision-making and provision of the most emergency care in any situation requires that all health care workers master the basics of resuscitation care.

^ Heart massage. The indication for cardiac massage is the cessation of effective contractions of the ventricles of the heart during asystole, ventricular fibrillation or terminal bradycardia. These conditions require immediate initiation of cardiac massage in combination with artificial ventilation.

Effective cardiac massage ensures sufficient blood supply to vital organs and often leads to recovery independent work hearts. The artificial ventilation of the lungs carried out in this case provides sufficient oxygen saturation of the blood.

In pre-hospital resuscitation, only indirect, or closed, cardiac massage is used (i.e., without opening the chest). Sharp pressure of the palm on the sternum leads to compression of the heart between the spine and sternum, reducing its volume and releasing blood into the aorta and pulmonary artery, i.e. is an artificial systole. At the moment the pressure stops, the chest expands, the heart takes on a volume corresponding to diastole, and blood from the vena cava and pulmonary veins enters the atria and ventricles of the heart. The rhythmic alternation of contractions and relaxations thus to some extent replaces the work of the heart, i.e. one of the types of artificial blood circulation is performed. When performing chest compressions, the patient should lie on a hard surface; if the patient is on the bed, then quickly place a shield under his back or place a stool under the bed net so that the thoracic spine rests against a hard surface; if the patient is on the ground or floor, there is no need to move him. The medical worker performing the massage should stand to the side of the victim, placing his palm closest to him. wrist joint part, on the lower third of the patient’s sternum, the second hand is placed on top of the first, so that the straight arms and shoulders of the massager are above the patient’s chest. Sharp pressure on the sternum with straight arms using body weight, leading to compression of the chest by 3-4 cm and compression of the heart between the sternum and spine, should be repeated 50-60 times per minute. Signs of the effectiveness of the massage are a change in previously dilated pupils, a decrease in cyanosis, pulsation of large arteries (primarily the carotid) in accordance with the frequency of the massage, and the appearance of independent respiratory movements. The massage should be continued until spontaneous heart contractions are restored, ensuring sufficient blood circulation. The indicator will be the pulse determined in the radial arteries and an increase in systolic arterial circulation to 80-90 mm Hg. Art. The absence of independent heart activity with undoubted signs of the effectiveness of the massage is an indication for continued cardiac massage. Carrying out a cardiac massage requires sufficient strength and endurance, therefore it is advisable to change the massager every 5-7 minutes, carried out quickly, without stopping the rhythmic cardiac massage. Taking into account the fact that artificial ventilation of the lungs is necessary simultaneously with cardiac massage, the optimal minimum of medical workers involved in resuscitation should be 3 people. When performing external cardiac massage, it should be taken into account that in elderly people the elasticity of the chest is reduced due to age-related ossification of the costal cartilages, therefore, with vigorous massage and too much compression of the sternum, rib fractures can occur. This complication is not a contraindication for continuing cardiac massage, especially if there are signs of its effectiveness. When performing a massage, you should not place your hand over the xiphoid process of the sternum, since sharply pressing on it can injure you. left lobe liver and other organs located in the upper part abdominal cavity. This is a serious complication of resuscitation measures.

^ Artificial ventilation. The indication for artificial ventilation is a sharp weakening or absence of spontaneous breathing, which usually occurs in terminal conditions. The task of artificial ventilation is to rhythmically pump air into the lungs in a sufficient volume, while exhalation is carried out due to the elasticity of the lungs and chest, i.e. passively. The most accessible and common method in pre-hospital resuscitation is the simple method of artificial respiration “mouth to mouth” or “mouth to nose”. In this case, a double “physiological norm” can be blown into the patient’s lungs - up to 1200 ml of air. This is quite enough, since healthy man during quiet breathing, he inhales about 600-700 ml of air. The air blown in by the person providing assistance is quite suitable for revival, as it contains 16% oxygen (compared to 21% in atmospheric air).

Artificial ventilation is effective only in cases where there are no mechanical obstructions in the upper respiratory tract and there is a seal in the air supply. If there are foreign bodies or vomit in the pharynx or larynx, it is first necessary to remove them (with a finger, clamps, suction, etc.) and restore the patency of the airways. When carrying out mouth-to-mouth or mouth-to-nose artificial ventilation, the patient's head should be tilted back as far as possible. In this position of the head, due to the displacement of the root of the tongue and epiglottis anteriorly, the larynx opens and provides Free access air through it into the trachea. The medical worker performing artificial respiration is located on the side of the victim, squeezes the nose with one hand, and opens the mouth with the other, lightly pressing on the patient’s chin. It is advisable to cover the patient’s mouth with gauze or a bandage, after which the medical worker performing artificial ventilation takes a deep breath, presses his lips tightly to the victim’s mouth and exhales vigorously, then the person providing assistance removes his lips from the patient’s mouth and moves his head to the side. Artificial inspiration is well controlled. At first, air is blown in easily, but as the lungs fill and stretch, resistance increases. With effective artificial respiration, you can clearly see how the chest expands during “inhalation.” Effective artificial respiration, carried out in combination with chest compressions, requires rhythmic repetition of energetic blows with a frequency of 12-15 per minute, i.e. one “inhalation” for 4-5 chest compressions. In this case, these manipulations should be alternated in such a way that the inflation does not coincide with the moment of compression of the chest during cardiac massage. In cases of preserved independent heart function, the frequency of artificial breaths should be increased to 20-25 per 1 min. Similar to the “mouth-to-mouth” method, “mouth-to-nose” breathing is carried out, while the patient’s mouth is covered with a palm or the lower lip is pressed against the upper lip with a finger.

Artificial ventilation is possible using portable hand-held breathing apparatus (type “Ambu”, RDA-1), which is an elastic rubber or plastic bag equipped with a special valve, or RPA-1 bellows. Breathing is carried out through a mask, which should be pressed tightly to the patient’s face (it is also possible to connect these devices to an endotracheal tube inserted into the patient’s trachea). When the bag or fur is compressed, air enters the patient’s lungs through the mask, and exhalation occurs into the surrounding air.

^ Acute vascular insufficiency.

1). Fainting.

This is a sudden short-term disturbance of consciousness that occurs as a result of anemia of the brain (in foreign literature - “syncope”). Reasons: sudden change in body position, severe straining, emotions, stuffy room, overheating in the sun, etc.). First aid: transfer the patient to a horizontal position with raised legs, take him out into fresh air, spray his face and chest with cold water, rub his legs and arms. Give ammonia a whiff. If consciousness does not return, then 1-2 ml of cordiamine or 1 ml of 10% caffeine solution can be administered subcutaneously.

2). ^ Collapse and shock.

More severe degrees of vascular insufficiency than fainting. Threatens the patient's life. There are no significant differences between the clinical manifestations of shock and collapse.

It is customary to talk about collapse in the case of the development of a “shock-like” syndrome due to one or another disease - infectious, intoxicating (barbiturate poisoning, overdose of antihypertensive drugs), etc.

Types of shock: hypovolemic (fluid loss, blood loss); cardiogenic (MI); bacterial (with sepsis); anaphylactic; traumatic; hemolytic, etc.

In the pathogenesis of shock, the following are of greatest importance: hypovolemia; s-s insufficiency; impaired blood circulation in tissues, especially brain hypoxia.

Clinic: lethargy, pallor, coldness and wetness of the skin, tachycardia, decreased blood pressure (below 80 mm Hg), decreased diuresis, thready pulse, intermittent and shallow breathing.

Treatment. Main directions of pharmacotherapy:

1). Correction of hypovolemia - transfusion of blood, plasma and plasma substitutes (albumin, polyglucin).

2). Elimination of pain syndrome - narcotic and non-narcotic analgesics.

3). Increased vascular tone (norepinephrine, mesaton, GK).

4). Restoration of breathing - respiratory analeptics (corazol, camphor, bemegride).

5). Increased contractility of the heart (glycoside and non-glycoside cardiotonic drugs).

Anaphylactic shock.

This is a general allergic reaction of an immediate type, caused by various antigens (drugs, serums, vaccines, insect bites, etc.), occurring a few minutes after the introduction of the antigen, characterized by a violent, severe course, often life-threatening for the patient. Shock reactions in infants to cow's milk have been described. Anaphylactic shock most often occurs due to drug allergies(antibiotics, novocaine, dicaine, lidocaine, B vitamins, aspirin, s/a, etc.).

Anaphylactic shock occurs with repeated exposure to an etiological factor. A pronounced picture of anaphylactic shock may be preceded by sensations of tingling and itching of the face, limbs, heat throughout the body, a feeling of fear and pressure in the chest, severe weakness, pain in the abdomen and in the heart area. These phenomena sometimes develop a few minutes (seconds) after exposure specific allergen. In the absence of immediate help, the described symptoms progress and after a few minutes the patient develops a state of shock. In some cases, anaphylactic shock develops very rapidly without any previous symptoms. In this case, a few seconds (minutes) after the administration of the drug or an insect bite, severe weakness, tinnitus, darkening of the eyes, fear of death appears, the patient loses consciousness, sometimes without even having time to report his feelings.

A picture of shock develops: pallor, cold sweat, rapid, thread-like pulse, collapsed veins, a sharp decrease in blood pressure. Clonic convulsions are possible. Often - death. In every department of the hospital, treatment room of the clinic, dental office, every pharmacy should have emergency aid available in case of anaphylactic shock.

Medicines necessary for organizing emergency care for

anaphylactic shock and other acute allergic diseases

First of all, the patient needs to be laid down and warmed (heating pads to the arms and legs). In case of food allergies or taking medications orally, it is necessary, if the patient’s condition allows, to rinse the stomach and intestines. In case of shock that develops after parenteral administration of drugs or an insect bite, you need to apply a tourniquet above the injection or bite site for 25-30 minutes, remove the sting and the bag of poison, inject this area with 0.5-1 ml of 0.1% adrenaline solution hydrochloride, apply ice to it. In the case of penicillin, it is necessary to administer a single intramuscular dose of 1,000,000 units of penicillinase, dissolved in 2 ml of isotonic sodium chloride solution, which destroys free penicillin, as early as possible.

Simultaneously with injecting the site of entry of the allergen with adrenaline, 0.5 ml of adrenaline diluted in 40-50 ml of isotonic sodium chloride solution is injected intravenously very slowly over 5-10 minutes into the opposite limb. These injections can be repeated every 10-15 minutes until the patient comes out of shock. If it is impossible to get into a vein, you need to inject 1 ml of 0.1% adrenaline solution subcutaneously, repeating, if necessary, these injections every 10-15 minutes until blood pressure normalizes. Simultaneously with adrenaline, 30-60 mg of prednisolone and 125-250 mg of hydrocortisone, as well as 2 ml of cordiamine or 2 ml of 10% caffeine solution should be administered intravenously, repeating the administration of these drugs depending on the severity of the condition every 6-12 hours.

Antihistamines (2 ml of 2.5% diprazine solution, 1 ml of 2% suprastin solution, etc.) are indicated during the period of precursors of shock (especially in the skin version) before the development of severe arterial hypotension, unconsciousness. After recovery from shock, they can be used only if urticaria, swelling, and itching of the skin persist. In case of development of left ventricular failure, an additional 0.5 ml of 0.05% strophanthin solution in 20 ml of 40% glucose solution is administered intravenously. For pulmonary edema, add 4-10 ml of 1% Lasix solution to the dropper. If the patient has convulsions and vomiting, 1-2 ml of 0.25% droperidol solution is prescribed.

The prognosis depends on the severity of the shock and the time of first aid. At severe forms and late emergency care is possible fatal outcome. Complications such as laryngeal edema, acute renal failure, and pulmonary edema are especially life-threatening. Most patients recovered from shock recover. However, if you come into contact with the allergen again, the shock may recur.

To prevent anaphylactic shock, you need to anticipate the possibility of its occurrence. Before prescribing drugs to patients or administering serums or vaccines, it is necessary to collect an allergy history.

^ Acute heart failure .

Cardiac asthma, pulmonary edema.

Develops with hypertension, ischemic heart disease, psycho-emotional and physical stress. There is a weakening of the heart (usually the left ventricle), which leads to a sudden overflow of blood into the pulmonary vessels, the liquid part of the blood sweats into the alveoli, forming foam, which leads to pulmonary edema.

Clinic: inspiratory dyspnea ( difficulty breathing). As a rule, an attack of suffocation occurs at night during sleep. The patient's condition sharply worsens, suffocation increases, respiratory rate is 40-60 per minute, breathing becomes bubbling and can be clearly heard at a distance, cough intensifies with the release of bloody, foamy sputum. The pulse is frequent and weak.

Treatment tactics:

1). The patient is placed in a sitting or semi-sitting position in bed.

2). Tourniquets are applied to both legs at the level of the upper 1/3 of the thigh (or bandaging the limbs) in order to compress only the venous vessels. Arterial pulse distal places should not disappear.

3). Venous bloodletting is possible (300-700 ml).

4). Hot foot baths. Circular banks.

5). Nitroglycerin 1t. under the tongue, up to 4 times with an interval of 5-10 minutes. Reduces pre- and afterload. But not with low blood pressure.

6). Furosemide (Lasix) IV 40-80 mg.

7). Morphine hydrochloride, fentanyl - reduce venous flow to the heart, cause peripheral vasodilation, and reduce the load on the heart. IV morphine 5-10 mg, fentanyl – 1-2 ml.

Neuroleptanalgesia: 1-2 ml 0.005% fentanyl solution+ 2-4 ml 0.25% droperidol solution = talamanal.

Oxygen therapy, defoamers (alcohol).

You can use strophanthin intravenously.

^ 3. Acute myocardial infarction myocardium.

This acute illness, caused by the development of foci of necrosis in the heart muscle (thrombosis or narrowing by an atherosclerotic plaque). Rarely, MI develops as a result of coronary artery spasm (in young people).

The focus of necrosis can be large in size (large-focal MI) or these foci can be small (small-focal MI). The outcome of MI is scarring of the necrosis focus - the so-called. post-infarction cardiosclerosis.

Symptoms Prolonged pain in the heart and behind the sternum. The pain occurs suddenly and quickly reaches significant intensity. Unlike pain with angina, the pain is much more intense and is not relieved by taking nitroglycerin.

Typical irradiation of pain is in the left shoulder, arm, under the left shoulder blade, lower jaw, interscapular area. Atypical irradiation – epigastric region, nausea, vomiting; attack of suffocation, palpitations. In the elderly it is a painless form.

During an attack of pain or suffocation, the patient experiences fear of death, he is pale, cold sweat appears on the forehead, and blood pressure decreases. ECG.

Complications: cardiogenic shock - a sharp drop in blood pressure (decreased myocardial contractile function), cold pale skin, sticky sweat, lethargy, confusion. Pulse is weak.

^ TREATMENT FOR THEM.

Call an ambulance immediately. Into the infarction block. Strict bed rest.

1. Relief of pain: narcotic analgesics, neuroleptanalgesia (droperidol + fentanyl = talamanal). Mask anesthesia - nitrous oxide.

2. Anticoagulant and fibrinolytic therapy - to stop the onset of thrombosis in the coronary artery. IV thrombolytic agents: fibrinolysin, streptokinase, urokinase.

Direct anticoagulants – heparin IV drip 5000-10000 units. Low molecular weight heparin - fraxiparin 0.3 ml into the abdominal skin 2-3 r/s. After 3-7 days - indirect anticoagulants: coumarin derivatives (neodicoumarin, syncumar) or phenylin.

Antiplatelet agents: aspirin (100-300 mg/s), ticlid (250 mg 1-2 times/s), dipyridamole (chimes) - 75 mg 3 times/s, pentoxifylline (trental), etc.

3. Limitation of the necrosis zone. IV drip nitroglycerin 1% 2 ml in 200 ml of isotonic sodium chloride solution. Polarizing mixture, beta blockers, calcium antagonists.

^ CARDIOGENIC SHOCK.

Complication of acute MI. Pain collapse - soon after the onset of the attack. Pale skin, low pulse, decreased blood pressure to 85/50 mm.

Mezaton IM, SC 1% - 0.5-1 ml or IV drip 1% - 1 ml per 40 ml isot. solution of sodium chloride or 5% glucose.

^ Sympathomimetic amines

Norepinephrine (stimulates alpha receptors of peripheral vessels and beta receptors of the heart, increases cardiac output, blood pressure, PSS, coronary and cerebral blood flow increases). IV drip 0.2% solution 2-4 ml in 1000 ml isot. solution - 10-15 drops per minute to 20-60 drops per minute.

USA: IV 500 ml saline. solution followed by administration of 500 ml/hour, because According to American doctors, patients with MI experience a decrease in blood volume due to acute redistribution of fluid within the body. We have rheopolyglucin or a polarizing mixture.

Dopamine– biological precursor of norepinephrine. IV drip 1-5 mcg/kg per minute with gradual increase up to 10-15 mcg/kg per minute. Dilute in 5% glucose solution or 0.9% isotonic. sodium chloride solution – 25 mg in 125 ml of solvent (200 μg/ml) or 200 mg in 400 ml (500 μg/ml ). Dobutamine(Dobutrex) – stimulates beta 1 adrenergic receptors. IV drip 2.5 mcg/kg per minute. Amrinon– IV drip 0.75 mg/kg up to 5-10 mcg/kg per minute.

Analgesics.

^ Acute abdomen syndrome.

1). Perforated ulcer stomach and duodenum.

Pain occurs suddenly, as if struck by a dagger in the stomach, very intense, constant. The patient's position is semi-bent, with the limbs brought to the stomach. The pain is localized in the upper abdomen, right hypochondrium. The stomach is hard as a board, retracted. The face is pale and covered with sweat. There may be vomiting "coffee grounds".

The patient should be immediately sent to the hospital. Until the diagnosis is clarified, heat, narcotic analgesics, enemas, and laxatives should not be used.

2). Biliary colic.

Attack biliary colic occurs as a result of strangulation of a stone in the neck of the bladder, in the ducts of cholelithiasis. An attack is provoked by errors in diet, physical or nervous overstrain. More often in women.

A sudden sharp pain appears in the right hypochondrium, in the epigastrium, radiating to the right shoulder, collarbone, scapula, right side base of the neck. The pain intensifies when lying on the left side.

The pain lasts from several hours to several days. Patients are restless. The pain is accompanied by nausea, vomiting of bile, which does not bring relief, sometimes jaundice of the sclera, and increased body temperature. A large stone (1-1.5 cm in D) can get stuck in the common gastrointestinal duct - obstructive jaundice.

Treatment: antispastic agents and analgesics. SC 0.1% solution 1.0 ml atropine sulfate, 2% solution 2.0 ml papaverine hydrochloride, 2% solution 2.0 ml no-shpa, 0.1% solution 1 .0 ml metacin. Nitroglycerin under the tongue. IN severe cases– narcotic analgesics, for example, iv 1% solution 1.0 ml of morphine hydrochloride in combination with atropine (to reduce the effect of morphine on the sphincter of Oddi). Bed rest. Light warmth may be applied to the stomach. It is better to abstain from eating for 1 day; tea with sugar is allowed.

3). Renal colic.

More often it manifests itself as a sudden, acute excruciating pain in the lumbar region, radiating along the ureter to the groin, genitals, leg. The attack is accompanied by dysuria, nausea, vomiting, and flatulence. The attack is caused by stretching of the pelvis by urine when its outflow is delayed. There may be dyspeptic symptoms and increased body temperature. Patients are restless and do not find a place for themselves. Hematuria.

Treatment: hot general medicinal bath, heating pads on the lumbar region and abdomen. Atropine injections IM, s/c. Narcotic analgesics, antispasmodics.

^ 4. Food poisoning.

A group of diseases that have a number of similar clinical manifestations, but are caused by different pathogens. The disease develops both as a result of exposure of the human body to toxins contained in food products and directly to pathogenic microorganisms.

Salmonellosis – most often associated with consumption of contaminated meat products, from animals, flies, rodents, humans. The onset is acute: chills, headache, weakness, fatigue, sleep disturbance, convulsions, loss of consciousness, decreased blood pressure. Sharp, cramping pain in the abdomen in the epigastrium, umbilical region, along the colon. Nausea, vomiting, rumbling in the stomach, flatulence, diarrhea. Loose stool mixed with mucus and blood. Bacteriological research.

Treatment. Gastric lavage through a tube or tubeless method (the patient drinks a large number of water or 0.02-0.1% potassium solution permanganate and induces vomiting). In total, rinsing takes 2-3 liters of liquid, until clean rinsing water leaves.

Replenishment of fluid loss: 5% glucose solution IV or isotonic solution of sodium chloride IV drip – 1-3 l. For seizures - antipsychotics (aminazine). For severe abdominal pain - antispasmodics, for prolonged diarrhea - calcium carbonate, tannin, bismuth preparations.

The use of AB and SA for some intestinal infections effective, but not for others (salmonellosis). You can use chloramphenicol, neomycin, tetracycline drugs, nitrofuran derivatives (furazolidone), as well as CA.

Diet. In mild forms, it is enough to follow a gentle diet for several days (mashed porridge, low-fat soups, boiled ground meat, jelly). It is prohibited to consume foods containing plant fiber, milk, and fried meat.

In case of severe food poisoning, the diet is more strict. On the first day, the patient abstains from eating and limits himself to drinking water and tea without sugar. In the following days they give tea with sugar, jelly, semolina porridge on water, crackers. In the future, as the patient’s condition improves, the diet is expanded.

Coma in patients with diabetes mellitus.

1). Hyperglycemic(hyperketonemic, ketoacidotic) coma.

This acute, serious complication of diabetes, caused by absolute insulin deficiency, is the final stage of metabolic disorders in diabetes. It is the result of self-poisoning of the body with products of incomplete breakdown of fats and proteins - ketone bodies (acetone, acetoacetic acid, etc.).

Usually develops gradually, sometimes over several days. Precursors of coma: general weakness, nausea, vomiting, polyuria, dryness, thirst. Then tachycardia, decreased blood pressure, and dehydration develop. Then the patient loses consciousness, the face is pale, the lips and tongue are dry, the skin is dry, the turgor of the tissues and eyeballs is reduced. Breathing is noisy and slower. There may be vomiting. A characteristic sign is the smell of acetone from the mouth. Hyperglycemia: 28-40 mmol/l.

Treatment. IV insulin 50-100 units + 50-100 units subcutaneously, oxygen therapy, ss agents (strophantine, cordiamine, mezaton). Ringer's solution or sodium chloride solution 0.9% 0.5-1.0 l in combination with vitamins B, C, cocarboxylase.

Under glycemic control, insulin is reintroduced every 2-3 hours at 20-30 units subcutaneously ( daily dose– 300-600 units).

^ 2). Hypoglycemic coma. A condition of the body characterized by a sharp decrease in blood sugar levels to 2.8 mmol/l or less. Carbohydrate starvation of the brain occurs, because Glucose is the main source of nutrition for the brain. Reason: insulin overdose, dietary violation (fasting), acute infectious diseases, physical exercise.

Clinic: warning signs - hunger, tremor, headache, sweating, irritability. Develops quickly. If this condition is not eliminated by the introduction of easily absorbed carbohydrates (sugar, honey, jam, white bread), then trembling in the body, double vision, sweating, and stiffness of movements intensify. There may be hallucinations and aggressiveness. According to these signs, the condition resembles alcohol intoxication or hysteria. If in this case, hypoglycemia remains unrecognized and is not eliminated in a timely manner, muscle cramps appear, general agitation increases, vomiting, clonic convulsions appear, consciousness becomes darkened and, finally, a deep coma occurs. Blood pressure drops, tachycardia, moist skin, pale face, trembling in the body, normal tone of the eyeballs, delirium.

Treatment. Quickly inject 20-100 ml of 40% glucose solution + vitamin C and cocarboxylase, oxygen therapy, s-s agents. There is no effect - after 10 minutes, 0.5-1.0 ml of 0.1% adrenaline solution is administered subcutaneously. There is no effect - after 10 minutes, 125-250 mg of hydrocortisone is administered intravenously or intramuscularly.

URGENT MEASURES

SELF-HELP AND MUTUAL HELP IN THE DEVELOPMENT OF ACUTE

LIFE-THREATENING DISEASES (CONDITIONS)

Memo for the patient

In our country, up to 80% of deaths occur outside of medical organizations - at home, at work, in the country, in public and other places. Most of them occur suddenly or by the mechanism of sudden death. However, with the knowledge of simple first aid techniques on the part of people surrounding a person who finds himself in such a critical condition, as well as everyone’s knowledge of first self-help measures, can in most cases save the patient’s life. In addition, statistics show that many patients themselves (or their relatives) call an emergency doctor late, which delays and reduces the likelihood of rescue.

This leaflet is addressed to almost all people, but especially to patients with cardiovascular diseases, with a high and very high risk of their development and complications, and their relatives and friends, since it is known that often a life-threatening complication, dangerously fatal, can be the first symptom of these diseases.

The leaflet is aimed at preventing and reducing the likelihood of fatal outcomes in life-threatening conditions; it describes clinical symptoms in relation to which one should be especially wary, and provides rational first-aid techniques while waiting for the arrival of an emergency physician.

I. FIRST AID FOR A HEART ATTACK

characteristic signs (symptoms) of a heart attack (myocardial infarction)

Sudden (paroxysmal) pressing, squeezing, burning, aching pain in the chest (behind the sternum) lasting more than 5 minutes;

Similar pains are often observed in the area of the left shoulder (forearm), left shoulder blade, left half of the neck and lower jaw, both shoulders, both arms, the lower part of the sternum along with top part belly;

Lack of air, shortness of breath, severe weakness, cold sweat, nausea often occur together and sometimes follow or precede discomfort/pain in the chest;

It is not uncommon for these manifestations of the disease to develop against the background of physical or psycho-emotional stress, but more often with some interval after them.

Uncharacteristic signs that are often confused with a heart attack:

Stitching, cutting, pulsating, boring, constant aching pain for many hours and not changing its intensity in the heart area or in a specific clearly defined area of the chest

Algorithm of urgent actions:

If you or someone else suddenly has the above characteristic signs of a heart attack, even at mild or moderate intensity, that last more than 5 minutes. - don’t hesitate, call an ambulance immediately. Do not wait more than 10 minutes - in such a situation it is life-threatening.

If you have symptoms of a heart attack and there is no way to call an ambulance, then ask someone to take you to the hospital - this is the only right decision. Never drive yourself unless you have no other choice.

In the most optimal scenario, if a heart attack occurs, you must follow the instructions received from your attending physician; if there are no such instructions, then you must act according to the following algorithm:

Call an emergency medical team.

Sit (preferably in a chair with armrests) or lie in bed with the head of the bed raised, take 0.25 g of acetylsalicylic acid (aspirin) (chew the tablet, swallow) and 0.5 mg of nitroglycerin (put the tablet/capsule under the tongue, first bite the capsule, do not swallow); free your neck and provide fresh air (open the vents or windows).

If after 5-7 minutes. After taking acetylsalicylic acid (aspirin) and nitroglycerin, the pain persists, you need to take nitroglycerin a second time.

If after 10 min. After taking the second dose of nitroglycerin, the pain persists; it is necessary to take nitroglycerin a third time.

If after the first or subsequent doses of nitroglycerin there is severe weakness, sweating, shortness of breath, you need to lie down, raise your legs (on a bolster, etc.), drink 1 glass of water and then, as with a severe headache, do not take nitroglycerin.

If the patient has previously taken cholesterol-lowering drugs from the statin group (simvastatin, lovastatin, fluvastatin, pravastatin, atorvastatin, rosuvoastatin), give the patient his usual daily dose and take the drug with you to the hospital.

Attention! A patient with a heart attack is strictly forbidden to get up, walk, smoke or eat until the doctor’s special permission;

Do not take aspirin (acetylsalicylic acid) if you are intolerant to it ( allergic reactions), as well as with obvious and exacerbation peptic ulcer stomach and duodenum;

Nitroglycerin should not be taken if there is severe weakness, sweating, or if there is severe headache, dizziness, or acute impairment of vision, speech, or coordination of movements.

II. FIRST AID FOR ACUTE CEREBRAL CIRCULATION IMPAIRMENT (ACI)

The main signs (symptoms) of acute cerebrovascular accident:

Numbness, weakness, “disobedience” or paralysis (immobility) of an arm, leg, half of the body, distortion of the face and/or drooling on one side;

Speech disorders (difficulty in choosing the right words, speech understanding and reading, slurred and unclear speech, up to total loss speech);

Impaired or loss of vision, double vision, difficulty focusing;

Impaired balance and coordination of movements (feelings of “swaying, sinking, body rotation, dizziness”, unsteady gait up to falling);

Unusually severe headache (often after stress or physical exertion);

Confusion or loss of consciousness, uncontrollable urination or bowel movements.

If any of these signs suddenly appear, call an ambulance immediately, even if these manifestations of the disease were observed for only a few minutes

Algorithm of urgent actions

1. Call an ambulance immediately, even if these manifestations of the disease were observed for only a few minutes

2. Before the arrival of the emergency medical team:

If the patient is unconscious, place him on his side and remove him from the mouth removable dentures(food debris, vomit), make sure the patient is breathing.

If the victim is conscious, help him take a comfortable sitting or semi-sitting position in a chair or on a bed, placing pillows under his back. Provide fresh air. Unbutton your shirt collar, belt, waistband, and remove tight clothing.

Measure your blood pressure if its upper level exceeds 220 mm Hg. Art., give the patient a drug that lowers blood pressure, which he took before.

Measure your body temperature. If the temperature is 38° or more, give the patient 1 g of paracetamol (2 tablets of 0.5 g, chew, swallow) (if paracetamol is not available, do not give other antipyretic drugs!).

Place ice on your forehead and head; you can take food from the freezer, placed in waterproof bags and wrapped in a towel.

If the patient has previously taken cholesterol-lowering drugs from the statin group (simvastatin, lovastatin, fluvastatin, pravastatin, atorvastatin, rosuvastatin), give the patient the usual daily dose.

If the victim has difficulty swallowing and saliva drips from his mouth, tilt his head towards the weaker side of the body and blot the dripping saliva with clean napkins.

If the victim is unable to speak or has slurred speech, reassure and reassure him that the condition is temporary. Hold his hand on the non-paralyzed side, stop him from trying to talk, and don't ask questions that require an answer. Remember that although the victim cannot speak, he is aware of what is happening and hears everything that is said around him.

Remember!

That only caused in the first 10 minutes. from the onset of a heart attack or stroke, emergency medical care allows full use of modern high-tech effective methods hospital treatment and reduce mortality from these diseases many times over.

What acetylsalicylic acid(aspirin) and nitroglycerin taken in the first minutes can prevent the development of myocardial infarction and significantly reduce the risk of death from it.

That the state of alcohol intoxication is not a reasonable basis for delaying calling an ambulance in the event of a heart attack and acute cerebrovascular accident - about 30% of people who died suddenly at home were intoxicated.

That closed cardiac massage performed in the first 60-120 seconds after sudden cardiac arrest allows up to 50% of patients to be brought back to life.

III. FIRST AID FOR HYPERTENSION CRISIS

Hypertensive crisis (Hc) is a condition manifested by high blood pressure (systolic “upper” blood pressure, usually more than 180 mm Hg; diastolic “lower” blood pressure - more than 120 mm Hg) and the following symptoms:

Headache, often in the occipital region, or heaviness and noise in the head;

Flashing “flies”, a veil or a net before the eyes;

Nausea, feeling of exhaustion, overwork, internal tension;

Shortness of breath, weakness, constant monotonous aching pain/discomfort in the heart area;

The appearance or increase in pastosity/swelling of the skin of the face, arms, legs.

First aid measures

If symptoms of a hypertensive crisis appear, you must:

Remove bright light, ensure peace, access to fresh air (unbutton your shirt collar, ventilate the room, etc.);

Measure blood pressure (see the method for measuring blood pressure at the end of this section) and if its “upper” level is higher than or equal to 160 mm Hg. Art., you must take an antihypertensive drug previously recommended by your doctor. In the absence of a doctor-recommended antihypertensive drug or when a blood pressure level is recorded above 200 mm Hg. Art. urgently need to call an ambulance.

Before emergency medical services arrive, you should, if possible, sit in a chair with armrests and take hot water. foot bath(put your feet in a container of hot water).

Attention! A patient with a hypertensive crisis is prohibited from any sudden movements (suddenly standing up, sitting down, lying down, bending over, pushing) and any physical activity.

After 40-60 minutes. after taking the medicine recommended by the doctor, it is necessary to re-measure blood pressure and if its level has not decreased by 20-30 mm Hg. Art. from the initial state and/or the condition has not improved - urgently call an ambulance.

If you feel better and your blood pressure decreases, you need to rest (go to bed with the head of the bed raised) and then contact your local (family) doctor.

When talking with your doctor, you need to clarify what medications you need to take if you develop a hypertensive crisis, clearly write down their names, dosage and time sequence (algorithm) for taking them, and also check with your doctor for what manifestations of the disease you need to urgently call an ambulance.

All patients with hypertension need to create an individual mini-first aid kit for a hypertensive crisis and carry it with them at all times, since a hypertensive crisis can develop at any time and anywhere.

Blood pressure measurement

To diagnose a hypertensive crisis, it is necessary to measure blood pressure, which is performed manually using a stethoscope (stethophonendoscope) and a special inflatable cuff equipped with a bulb pump and a sphygmamanometer (Fig. 1), as well as an automatic (semi-automatic) method using various models of tonometers, specially designed for these purposes (Fig. 2)

┌───────────────────────────────────┬──────────────────────────────────

Rice. 1. Stethoscope (left) Fig. 2. Tonometer

And an inflatable cuff equipped for automatic measurement

Bulb pump and blood pressure sphygmomanometer

(not given)

The accuracy of blood pressure measurement and, accordingly, the guarantee of correct diagnosis and severity of a hypertensive crisis depend on compliance with the rules for its measurement.

The measurement should be taken while sitting (leaning on the back of a chair, with relaxed and uncrossed legs, the hand resting on the table, at heart level), in a calm environment, after a 5-minute rest. During the measurement, you should not actively move or talk. In special cases, blood pressure can be measured while lying down or standing.

The cuff is placed on the shoulder, its lower edge 2 cm above the elbow. The size of the cuff must correspond to the size of the arm: the rubber inflated part of the cuff must cover at least 80% of the shoulder circumference; for adults, a cuff 12-13 cm wide and 30-35 cm long (average size) is used; It is necessary to have large and small cuffs available for fat and thin arms, respectively.

Before starting the measurement, the mercury column or sphygmomanometer needle should be at the zero mark and in front of the researcher’s eyes. (Fig. 3)

Rice. 3. Illustration of rules for measuring blood pressure

Blood pressure measurement technique:

Place the head of the phonendoscope in the cubital fossa above the brachial artery passing through it (Fig. 3);

Quickly inflate the cuff to a pressure of 20-30 mm Hg. Art. higher than usual for this person the level of “upper” systolic blood pressure (if the measurement is made for the first time, the pressure level in the cuff is usually raised to 160 mm Hg). If at this pressure level the pulsation of the vessel in the cubital fossa remains, then the pressure in the cuff continues to be increased to a level of 20 mm Hg. Art. exceeding the pressure level at which the pulsation of the artery in the cubital fossa disappeared);

Open the air release valve from the cuff, located next to the pump bulb, and reduce the pressure in the cuff at a speed of approximately 2-3 mmHg. Art. per second;

During the process of releasing air from the cuff, two parameters are simultaneously monitored:

1) pressure level on the pressure gauge scale and

2) the appearance of pulsation sounds (called Korotkoff sounds) of the artery in the cubital fossa. The pressure level at the moment of the appearance of pulsation tones corresponds to the level

"upper" systolic blood pressure, and the pressure level at the moment of complete disappearance of artery pulsation sounds corresponds to

"lower" diastolic blood pressure (in children, adolescents and young adults immediately after physical activity, in pregnant women and in some pathological conditions in adults, the sounds of arterial pulsation do not disappear, then the “lower” diastolic blood pressure should be determined by the moment of significant weakening of the sounds).

If the pulsation sounds of the artery in the cubital fossa are very weak, then you should raise your hand and perform several squeezing movements with the hand, then repeat the measurement, but do not strongly compress the artery with the phonendoscope membrane;

When measuring blood pressure yourself, the head of the phonendoscope is fixed above the cubital fossa using a cuff.

For a reliable assessment of blood pressure, it is necessary to perform at least two blood pressure measurements on each arm with an interval of at least a minute (in the pauses between measurements, the cuff must be completely loosened); when a pressure difference of more than 5 mm Hg is detected. Art. make one additional measurement; The average of the last two measurements is taken as the final (recorded) value.

IV. FIRST AID FOR ACUTE HEART FAILURE

Acute heart failure (AHF) is a severe pathological condition that develops in patients with various diseases heart and hypertension. This is one of the most common reasons emergency calls and hospitalization of patients, as well as mortality of the population of our country and the whole world.

The main manifestations (symptoms) of acute heart failure are:

Heavy, frequent (more than 24 per minute) noisy breathing - shortness of breath, sometimes reaching the level of suffocation, with predominant difficulty in inhaling and a clear increase in shortness of breath and cough in a horizontal position. A sitting position or a lying position with the head of the head raised up alleviates the patient's condition;

Often, when breathing, wet squelching wheezing/sounds, interrupted by coughing, become audible; in the terminal stage, breathing takes on a bubbling character with the appearance of foam at the patient’s mouth;

The characteristic sitting posture of the patient is resting his straight arms on his knees.

Acute heart failure can develop very quickly and lead to the death of the patient within 30-60 minutes. In most cases, 6-12 or more hours pass from the first clinical signs to severe manifestations of AHF, but without medical care, the absolute majority of patients with AHF die.

First aid measures

When the above symptoms of AHF appear in patients with hypertension or heart disease (but not lungs or bronchi), it is necessary:

Call an ambulance

Give the patient a sitting position, preferably in a chair with armrests on which he can lean and engage the intercostal muscles in the act of breathing

Provide physical and psycho-emotional peace and fresh air by ventilating the room

Place your feet in a large container (basin, tank, bucket, etc.) with hot water

In extremely severe cases, tourniquets are applied to the legs in the groin area, compressing superficial veins, but not deep arteries, which reduces blood flow to the heart and thereby facilitates its work

If the patient or the person providing first aid has experience in the use of nitroglycerin, it is prescribed in a dose of 0.4 (0.5) mg (inhalation into the oral cavity is carried out under the root of the tongue, the tablet/capsule is placed under the tongue, the capsule must first be bitten, do not swallow). If the patient’s well-being improves after using nitroglycerin, it is reapplied every 5-10 minutes. until the emergency medical team arrives. If there is no improvement in the patient's well-being after using nitroglycerin, it is no longer used.

Attention! A patient with AHF is strictly forbidden to get up, walk, smoke, drink water and take liquid food until special permission from the doctor; Nitroglycerin should not be taken if blood pressure is less than 100 mm Hg. Art. with severe headache, dizziness, acute impairment of vision, speech or coordination of movements.

All patients with hypertension or heart disease with shortness of breath and swelling in the legs should discuss with their doctor what medications should be taken if AHF develops, clearly write down their names, dosage and time sequence (algorithm) for taking them, and also check with the doctor if what manifestations of the disease require urgent medical attention. Each such patient needs to create an individual first aid kit for AHF and constantly have it with him.

V. SUDDEN DEATH

Most often, sudden death occurs due to the sudden cessation of cardiac activity.

The main signs (symptoms) of sudden death:

Sudden loss of consciousness, often accompanied by agonal movements (a standing or sitting person falls, convulsive muscle tension, involuntary urination and defecation are often observed; a lying person sometimes makes a convulsive attempt to sit up or turn on his side)

Sudden complete cessation of breathing, often after a short period (5-10 seconds) of agonal pseudobreathing: the patient makes wheezing and/or gurgling sounds, sometimes similar to a convulsive attempt to say something.

Sequence of urgent actions.

If a person suddenly loses consciousness, immediately call an ambulance team (if there are other people nearby, they call an ambulance). Next, shake the patient by the shoulder and ask loudly, “What’s wrong with you?” If there is no response, active patting is performed on the patient’s cheeks; if there is no reaction, immediately begin closed cardiac massage.

The patient is placed on a hard, flat surface (floor, ground, flat hard area and similar places, but not on a sofa, bed, mattress and other soft surfaces), and the front part of the chest is freed from clothing. Determine the location of the hands on the patient’s chest, as indicated in the figure. One palm is placed in the place indicated in the figure, and the palm of the second hand is placed on top of the first in exact accordance with the image of the hands in the figure.

With straight arms (not bent at the elbows), vigorous rhythmic compression of the victim’s chest is performed to a depth of 5 cm with a frequency of 100 compressions per chest per minute (method closed massage the heart is shown schematically in Figure 5).

When signs of life appear (any reactions, facial expressions, movements or sounds made by the patient), cardiac massage must be stopped. If these signs of life disappear, heart massage must be resumed. Stops of cardiac massage should be minimal - no more than 5-10 seconds. When signs of life resume, the heart massage stops, and the patient is provided with warmth and peace. If there are no signs of life, cardiac massage continues until the arrival of an emergency medical team.

If the first aid provider has special training and experience in performing cardiopulmonary resuscitation, he can perform artificial ventilation in parallel with closed cardiac massage. In the absence of special training, perform artificial ventilation on the patient and determine the pulse at carotid artery should not, since special scientific studies have shown that such procedures in inexperienced hands lead to an unacceptable loss of time and sharply reduce the frequency of revival of patients with sudden cardiac arrest.

Rice. 5. Illustration of the technique of closed cardiac massage