Providing medical care in emergency situations. Emergency conditions and emergency medical care. Algorithm of actions in case of emergency conditions. Hypertensive crisis complicated by pulmonary edema

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fainting
Collapse
Hypertensive crisis
Anaphylactic shock
Angina attack
Acute myocardial infarction
Clinical death

Algorithms for providing first medical care in case of emergency

Fainting

Fainting is an attack of short-term loss of consciousness caused by transient cerebral ischemia associated with weakening of cardiac activity and acute dysregulation of vascular tone. Depending on the severity of factors contributing to cerebrovascular accident.

There are: cerebral, cardiac, reflex and hysterical types of fainting states.

Stages of development of fainting.

1. Precursors (pre-fainting state). Clinical manifestations: discomfort, dizziness, tinnitus, lack of air, cold sweat, numbness of the fingertips. Lasts from 5 seconds to 2 minutes.

2. Impaired consciousness (fainting itself). Clinic: loss of consciousness lasting from 5 seconds to 1 minute, accompanied by pallor, decreased muscle tone, dilated pupils, and weak reaction to light. Shallow breathing, bradypnea. The pulse is labile, most often bradycardia up to 40 - 50 per minute, systolic blood pressure decreases to 50 - 60 mm. rt. Art. With deep fainting, convulsions are possible.

3. Post-syncope (recovery) period. Clinic: correctly oriented in space and time, pallor, rapid breathing, labile pulse and low blood pressure may persist.

Algorithm of treatment measures

2. Unfasten the collar.

3. Provide access fresh air.

4. Wipe your face wet wipe or irrigate with cold water.

5. Inhalation of ammonia vapor (reflex stimulation of the respiratory and vasomotor centers).

If the above measures are ineffective:

6. Caffeine 2.0 IV or IM.

7. Cordiamine 2.0 i/m.

8. Atropine (for bradycardia) 0.1% - 0.5 s.c.

9. When leaving fainting continue dental procedures while taking measures to prevent relapse: treatment should be carried out with the patient in a horizontal position with adequate premedication and sufficient anesthesia.

Collapse

Collapse is a severe form of vascular insufficiency (decreased vascular tone), manifested by a decrease in blood pressure, dilation of venous vessels, a decrease in the volume of circulating blood and its accumulation in blood depots - the capillaries of the liver and spleen.

Clinical picture: sharp deterioration general condition, severe pallor of the skin, dizziness, chills, cold sweat, a sharp decrease in blood pressure, rapid and weak pulse, frequent, shallow breathing. Peripheral veins become empty, their walls collapse, which makes venipuncture difficult. Patients remain conscious (if they faint, patients lose consciousness), but are indifferent to what is happening. Collapse may be a symptom of such severe pathological processes, such as myocardial infarction, anaphylactic shock, bleeding.

Algorithm of therapeutic measures 1. Give the patient horizontal position.

2. Provide a flow of fresh air.

3. Prednisolone 60-90 mg IV.

4. Norepinephrine 0.2% - 1 ml IV in 0.89% sodium chloride solution.

5. Mezaton 1% - 1 ml IV (to increase venous tone).

6. Korglyukol 0.06% - 1.0 IV slowly in 0.89% sodium chloride solution.

7. Polyglucin 400.0 IV drip, 5% glucose solution IV drip 500.0.

Hypertensive crisis

Hypertensive crisis is a sudden rapid increase in blood pressure, accompanied by clinical symptoms from the target organs (usually the brain, retina, heart, kidneys, gastrointestinal tract, etc.).

Clinical picture. Severe headaches, dizziness, tinnitus, often accompanied by nausea and vomiting. Visual impairment (mesh or fog before the eyes). The patient is excited. In this case, there is trembling of the hands, sweating, and sharp redness of the skin of the face. The pulse is tense, blood pressure is increased by 60-80 mm. rt. Art. compared to usual. During a crisis, angina attacks and acute cerebrovascular accident may occur.

Algorithm of treatment measures 1. Intravenously in one syringe: dibazol 1% - 4.0 ml with papaverine 1% - 2.0 ml (slow).

2. When severe course: clonidine 75 mcg sublingually.

3. Intravenous Lasix 1% - 4.0 ml in saline solution.

4. Anaprilin 20 mg (for severe tachycardia) under the tongue.

5. Sedatives- Elenium 1-2 tablets orally.

6. Hospitalization.

It is necessary to constantly monitor blood pressure!

first health care fainting

Anaphylactic shock

A typical form of drug-induced anaphylactic shock (DAS).

The patient experiences an acute state of discomfort with vague painful sensations. A fear of death or a state of internal anxiety appears. Nausea, sometimes vomiting, and cough are observed. Patients complain about severe weakness, feeling of tingling and itching of the skin of the face, hands, head; a feeling of a rush of blood to the head, face, a feeling of heaviness behind the sternum or compression chest; the appearance of pain in the heart area, difficulty breathing or the inability to exhale, dizziness or headache. Disorder of consciousness occurs in the terminal phase of shock and is accompanied by disturbances in speech contact with the patient. Complaints arise immediately after taking the drug.

Clinical picture of LAS: hyperemia of the skin or pallor and cyanosis, swelling of the eyelids of the face, profuse sweating. Breathing is noisy, tachypnea. Most patients develop motor restlessness. Mydriasis is noted, the reaction of the pupils to light is weakened. The pulse is frequent, sharply weakened in the peripheral arteries. Blood pressure decreases quickly, in severe cases diastolic pressure not determined. Shortness of breath and difficulty breathing appear. Subsequently it develops clinical picture pulmonary edema.

Depending on the severity of the course and the time of development of symptoms (from the moment of antigen administration), fulminant (1-2 minutes), severe (after 5-7 minutes), moderate severity (up to 30 minutes) forms of shock are distinguished. The shorter the time from drug administration to the onset of clinical symptoms, the more severe the shock, and the less chance of a successful treatment outcome.

Algorithm of treatment measures Urgently provide access to the vein.

1. Stop administering the drug that caused anaphylactic shock. Call an ambulance for yourself.

2. Lay the patient down and lift him up lower limbs. If the patient is unconscious, turn the head to the side, move lower jaw. Inhalation of humidified oxygen. Ventilation of the lungs.

3. Inject intravenously 0.5 ml of a 0.1% solution of adrenaline in 5 ml of isotonic sodium chloride solution. If venipuncture is difficult, adrenaline is injected into the root of the tongue, possibly intratracheally (a puncture of the trachea below the thyroid cartilage through the conical ligament).

4. Prednisolone 90-120 mg IV.

5. Diphenhydramine solution 2% - 2.0 or suprastin solution 2% - 2.0, or diprazine solution 2.5% - 2.0 IV.

6. Cardiac glycosides according to indications.

7. For obstruction respiratory tract- oxygen therapy, 2.4% aminophylline solution 10 ml intravenously per physical. solution.

8. If necessary, endotracheal intubation.

9. Hospitalization of the patient. Allergy identification.

Toxic reactions to anesthetics

Clinical picture. Anxiety, tachycardia, dizziness and weakness. Cyanosis, muscle tremors, chills, convulsions. Nausea, sometimes vomiting. Respiratory disorder, decreased blood pressure, collapse.

Algorithm of treatment measures

1. Place the patient in a horizontal position.

2. Fresh air. Allow the ammonia vapor to inhale.

3. Caffeine 2 ml s.c.

4. Cordiamine 2 ml s.c.

5. In case of respiratory depression - oxygen, artificial respiration (according to indications).

6. Adrenaline 0.1% - 1.0 ml per physical. i.v. solution

7. Prednisolone 60-90 mg IV.

8. Tavegil, suprastin, diphenhydramine.

9. Cardiac glycosides (according to indications).

Angina attack

An attack of angina pectoris is a paroxysm of pain or other unpleasant sensations (heaviness, compression, pressure, burning) in the heart area lasting from 2-5 to 30 minutes with characteristic irradiation (in left shoulder, neck, left shoulder blade, lower jaw), caused by an excess of myocardial oxygen consumption over its supply.

An angina attack is provoked by an increase in blood pressure and psycho-emotional stress, which always occurs before and during treatment by a dentist.

Algorithm of treatment measures 1. Termination of dental intervention, rest, access to fresh air, free breathing.

2. Nitroglycerin in tablets or capsules (bite the capsule) 0.5 mg under the tongue every 5-10 minutes (total 3 mg under blood pressure control).

3. If the attack is stopped, recommendations for outpatient monitoring by a cardiologist. Resumption of dental benefits - upon stabilization of the condition.

4. If the attack is not stopped: baralgin 5-10 ml or analgin 50% - 2 ml IV or IM.

5. If there is no effect, call an ambulance and hospitalization.

Acute myocardial infarction

Acute myocardial infarction is ischemic necrosis of the heart muscle, resulting from an acute discrepancy between the need for oxygen in the myocardium and its delivery through the corresponding coronary artery.

Clinic. The most characteristic clinical symptom is pain, which is often localized in the region of the heart behind the sternum, less often affecting the entire anterior surface of the chest. Irradiates to left hand, shoulder, scapula, interscapular space. The pain usually has a wave-like character: it increases and decreases, it lasts from several hours to several days. Objectively, pallor of the skin, cyanosis of the lips, increased sweating, decreased blood pressure. In most patients it is impaired heartbeat(tachycardia, extrasystole, atrial fibrillation).

Algorithm of treatment measures

1. Urgent cessation of intervention, rest, access to fresh air.

2. Call the cardiology ambulance team.

3. With systolic blood pressure? 100 mm. rt. Art. sublingually 0.5 mg of nitroglycerin tablets every 10 minutes (total dose 3 mg).

4. Mandatory docking pain syndrome: baralgin 5 ml or analgin 50% - 2 ml IV or IM.

5. Oxygen inhalation through a mask.

6. Papaverine 2% - 2.0 ml IM.

7. Eufillin 2.4% - 10 ml per saline. i.v. solution

8. Relanium or Seduxen 0.5% - 2 ml 9. Hospitalization.

Clinical death

Clinic. Loss of consciousness. Absence of pulse and heart sounds. Stopping breathing. Pale and cyanotic skin and mucous membranes, absence of bleeding from the surgical wound (tooth socket). Pupil dilation. Respiratory arrest usually precedes cardiac arrest (in the absence of breathing, the pulse remains at carotid arteries and the pupils are not dilated), which is taken into account during resuscitation.

Algorithm of therapeutic measures RESUSCITATION:

1. Lay on the floor or couch, throw back your head, push out your jaw.

2. Clear the airways.

3. Insert an air duct, perform artificial ventilation and external cardiac massage.

during resuscitation by one person in the ratio: 2 breaths per 15 sternal compressions; during resuscitation by two people in the ratio: 1 breath per 5 compressions of the sternum. Keep in mind that the frequency of artificial respiration is 12-18 per minute, and the frequency of artificial circulation is 80-100 per minute. Artificial ventilation and external cardiac massage are carried out before the arrival of the "resuscitation".

During resuscitation, all drugs are administered only intravenously, intracardiacly (adrenaline is preferable - intertracheally). After 5-10 minutes, the injections are repeated.

1. Adrenaline 0.1% - 0.5 ml in a dilution of 5 ml. physical solution or glucose intracardially (preferably intertracheally).

2. Lidocaine 2% - 5 ml (1 mg per kg of weight) IV, intracardiac.

3. Prednisolone 120-150 mg (2-4 mg per kg of weight) IV, intracardially.

4. Sodium bicarbonate 4% - 200 ml i.v.

5. Ascorbic acid 5% - 3-5 ml i.v.

6. Cold head.

7. Lasix according to indications: 40-80 mg (2-4 ampoules) IV.

Resuscitation is carried out taking into account the existing asystole or fibrillation, which requires electrocardiographic data. When diagnosing fibrillation, a defibrillator is used (if one is available), preferably before drug therapy.

In practice, all of the above activities are carried out simultaneously.

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How to provide emergency care to a patient?

The administration of medications or other allergens should be stopped and a tourniquet should be applied proximal to the allergen injection site. Help must be provided on the spot; for this purpose, it is necessary to lay the patient down and fix the tongue to prevent asphyxia. Inject 0.5 ml of 0.1% adrenaline solution subcutaneously at the site of allergen injection (or at the site of the bite) and 1 ml of 0.1% adrenaline solution intravenously. If blood pressure remains low, the injection of adrenaline solution should be repeated after 10-15 minutes. Corticosteroids are of great importance for removing patients from anaphylactic shock. Prednisolone should be administered into a vein at a dose of 75-150 mg or more; dexamethasone - 4-20 mg; hydrocortisone - 150-300 mg; If it is not possible to inject corticosteroids into a vein, they can be administered intramuscularly. Administer antihistamines: pipolfen - 2-4 ml of a 2.5% solution subcutaneously, suprastin - 2-4 ml of a 2% solution or diphenhydramine - 5 ml of a 1% solution. For asphyxia and suffocation, administer 10-20 ml of a 2.4% solution of aminophylline intravenously, alupent - 1-2 ml of a 0.05% solution, and isadrin - 2 ml of a 0.5% solution subcutaneously. If signs of heart failure appear, administer corglicon - 1 ml of 0.06% solution in isotonic sodium chloride solution, lasix (furosemide) 40-60 mg intravenously in a rapid stream in isotonic sodium chloride solution. If allergic reaction developed on the administration of penicillin, administer 1,000,000 units of penicillinase in 2 ml of isotonic sodium chloride solution. The administration of sodium bicarbonate (200 ml of 4% solution) and anti-shock fluids is indicated. If necessary, resuscitation measures are carried out, including closed cardiac massage, artificial respiration, and bronchial intubation. For laryngeal edema, tracheostomy is indicated.

What are the clinical manifestations of arterial hypotension?

With arterial hypotension it is noted headache dull, pressing nature, sometimes paroxysmal throbbing pain, accompanied by nausea and vomiting. During a headache attack, patients are pale, the pulse is weak, and blood pressure drops to 90/60 mmHg. Art. and below.

2 ml of a 20% caffeine solution or 1 ml of a 5% ephedrine solution are administered. No hospitalization required.

What is characteristic of heart pain caused by angina pectoris?

The most important point in the treatment of angina pectoris is the relief of painful attacks. A painful attack during angina pectoris is characterized by compressive pain behind the sternum, which can occur either after physical activity(angina pectoris) or at rest (angina pectoris at rest). The pain lasts for several minutes and is relieved by taking nitroglycerin.

To relieve an attack, the use of nitroglycerin is indicated (2-3 drops of a 1% alcohol solution or in tablets of 0.0005 g). The drug must be absorbed into the oral mucosa, so it should be placed under the tongue. Nitroglycerin causes vasodilation of the upper half of the body and coronary vessels. If nitroglycerin is effective, the pain goes away within 2-3 minutes. If the pain does not disappear a few minutes after taking the drug, you can take it again.

For severe, prolonged pain, 1 ml of a 1% morphine solution with 20 ml of a 40% glucose solution can be administered intravenously. The infusion is done slowly. Considering that a severe prolonged attack of angina pectoris can be the onset of myocardial infarction, in cases where intravenous administration of narcotic analgesics is required, 5000-10000 units of heparin should be administered intravenously along with morphine (in the same syringe) to prevent thrombosis.

An analgesic effect is achieved by intramuscular injection of 2 ml of a 50% analgin solution. Sometimes its use makes it possible to reduce the dose of administered narcotic analgesics, since analgin enhances their effect. Sometimes a good analgesic effect is obtained by applying mustard plasters to the heart area. Skin irritation causes reflex expansion coronary arteries and improves blood supply to the myocardium.

What are the main causes of myocardial infarction?

Myocardial infarction is necrosis of a section of the heart muscle that develops as a result of a disruption in its blood supply. The immediate cause of myocardial infarction is the closure of the lumen of the coronary arteries or narrowing by an atherosclerotic plaque or thrombus.

The main symptom of a heart attack is severe compressive pain behind the sternum on the left. The pain radiates to the left shoulder blade, arm, and shoulder. Repeated repeated administration of nitroglycerin during a heart attack does not relieve pain; it can last for hours, and sometimes for days.

Emergency care in the acute stage of a heart attack includes, first of all, relieving the pain attack. If preliminary repeated intake of nitroglycerin (0.0005 g per tablet or 2-3 drops of 1% alcohol solution) did not relieve the pain, it is necessary to administer promedol (1 ml of 2% solution), pantopon (1 ml of 2% solution) or morphine (1 ml of 1% solution) subcutaneously along with 0.5 ml of 0.1% atropine solution and 2 ml of cordiamine . If subcutaneous administration of narcotic analgesics does not have an analgesic effect, you should resort to intravenous infusion of 1 ml of morphine with 20 ml of 40% glucose solution. Sometimes anginal pain can be relieved only with the help of anesthesia with nitrous oxide mixed with oxygen in a ratio of 4:1, and after the pain stops - 1:1. IN last years To relieve pain and prevent shock, fentanyl 2 ml of a 0.005% solution is used intravenously with 20 ml of saline. Together with fentanyl, 2 ml of a 0.25% solution of droperidol is usually administered; This combination enhances the pain-relieving effect of fentanyl and makes it last longer. The use of fentanyl soon after administration of morphine is undesirable due to the risk of respiratory arrest.

The complex of emergency measures in the acute stage of myocardial infarction includes the use of drugs against acute vascular and heart failure and direct-acting anticoagulants. With a slight decrease in blood pressure, sometimes cordiamine, caffeine, and camphor administered subcutaneously are sufficient. A significant drop in blood pressure (below 90/60 mm Hg), the threat of collapse requires the use of more powerful means- 1 ml of 1% mesatone solution or 0.5-1 ml of 0.2% norepinephrine solution subcutaneously. If collapse persists, these drugs should be re-administered every 1-2 hours. In these cases, intramuscular injections of steroid hormones (30 mg of prednisolone or 50 mg of hydrocortisone), which help normalize vascular tone and blood pressure, are also indicated.

What are the general characteristics of an asthma attack?

The main manifestation of bronchial asthma is an attack of suffocation with dry wheezing audible from a distance. Often an attack of atonic bronchial asthma is preceded by a prodromal period in the form of rhinitis, itching in the nasopharynx, dry cough, and a feeling of pressure in the chest. An attack of atonic bronchial asthma usually occurs upon contact with an allergen and quickly ends when such contact is stopped.

If there is no effect, administer glucocorticoids intravenously: 125-250 mg of hydrocortisone or 60-90 mg of prednisolone.

What are the manifestations and causes of collapse?

Collapse - acute vascular insufficiency, which is manifested by a sharp decrease in blood pressure and disorder peripheral circulation. The most common causes of collapse are massive blood loss, trauma, myocardial infarction, poisoning, acute infections etc. Collapse can be the direct cause of death of the patient.

The patient's appearance is characteristic: pointed facial features, sunken eyes, pale gray skin color, small beads of sweat, cold bluish extremities. The patient lies motionless, lethargic, lethargic, and less often restless; breathing is rapid, shallow, pulse is frequent, small, soft. Blood pressure drops: the degree of its decrease characterizes the severity of the collapse.

The severity of symptoms depends on the nature of the underlying disease. Thus, during acute blood loss, the pallor of the skin and visible mucous membranes is striking; with myocardial infarction, one can often notice bluishness of the facial skin, acrocyanosis, etc.

In case of collapse, the patient must be placed in a horizontal position (pillows removed from under the head) and heating pads placed on the limbs. Call a doctor immediately. Before his arrival, the patient must be given cardiovascular drugs (cordiamin, caffeine) subcutaneously. As prescribed by the doctor, a set of measures is carried out depending on the cause of the collapse: hemostatic therapy and blood transfusion for blood loss, administration of cardiac glycosides and painkillers for myocardial infarction, etc.

What is a coma?

Coma is called unconsciousness with profound impairment of reflexes, lack of response to stimulation.

The general and main symptom of a coma of any origin is a deep loss of consciousness caused by damage to vital parts of the brain.

Coma can occur suddenly in the midst of relative well-being. Acute development is typical for cerebral coma with stroke, hypoglycemic coma. However, in many cases, a comatose state, complicating the course of the disease, develops gradually (with diabetic, uremic, hepatic coma and many other comatose states). In these cases, coma, a deep loss of consciousness, is preceded by a precoma stage. Against the background of increasing exacerbation of the symptoms of the underlying disease, signs of damage to the central nervous system in the form of stupor, lethargy, indifference, confusion of consciousness with periodic clarifications. However, during this period, patients retain the ability to respond to strong irritations, with a delay, in monosyllables, but still respond to loud asked question, they retain pupillary, corneal and swallowing reflexes. Knowledge of the symptoms of a precomatous state is especially important, since often timely provision of assistance during this period of illness prevents the development of coma and saves the life of the patient.

Hepatic coma. Vomiting "Coffee Grounds"

When examining the skin, it should be taken into account that with uremia, thrombosis of cerebral vessels, and anemia, the skin is pale. In alcoholic coma or cerebral hemorrhage, the face is usually hyperemic. Pink coloration of the skin is characteristic of coma due to carbon monoxide poisoning. Yellowness of the skin is usually observed in hepatic coma. Determining the moisture content of the skin of a patient in a coma is important. Moist, sweaty skin is characteristic of a hypoglycemic coma. In a diabetic coma, the skin is always dry. Traces of old scratching on the skin can be noted in patients with diabetic, hepatic and uremic coma. Fresh boils, as well as skin scars from old boils found in comatose patients, suggest diabetes mellitus.

The study of skin turgor is of particular importance. In some diseases accompanied by dehydration of the body and leading to the development of coma, there is a significant decrease in skin turgor. This symptom is especially pronounced in diabetic coma. A similar decrease in the turgor of the eyeballs in diabetic coma makes them soft, which is easily determined by palpation.

Treatment of coma depends on the nature of the underlying disease. In a diabetic coma, the patient is administered insulin subcutaneously and intravenously, sodium bicarbonate, and saline as prescribed by the doctor.

Hypoglycemic coma is preceded by a feeling of hunger, weakness and trembling throughout the body. Before the doctor arrives, the patient is given sugar or sweet tea. 20-40 ml of 40% glucose solution is injected into a vein.

In uremic coma, therapeutic measures are aimed at reducing intoxication. For this purpose, the stomach is washed, a cleansing enema is given, an isotonic sodium chloride solution and a 5% glucose solution are injected dripwise.

In case of hepatic coma, glucose solutions, steroid hormones, and vitamins are administered dropwise as prescribed by the doctor.

What is the pathogenesis and main causes of fainting?

Fainting is a sudden short-term loss of consciousness with weakening of the cardiac and respiratory systems. Fainting is a mild form of acute vascular brain failure and is caused by anemia of the brain; occurs more often in women. Fainting can occur as a result of mental trauma, the sight of blood, painful stimulation, or long stay in a stuffy room, in case of intoxication and infectious diseases.

The severity of fainting may vary. Typically, fainting is characterized by the sudden onset of mild fogging of consciousness in combination with non-systemic dizziness, ringing in the ears, nausea, yawning, and increased intestinal motility. Objectively, a sharp pallor of the skin, coldness of the hands and feet, beads of sweat on the face, and dilated pupils are noted. The pulse is weak, blood pressure is reduced. The attack lasts several seconds.

In more severe cases, fainting occurs total loss consciousness with the switching off of muscle tone, the patient slowly settles down. At the height of fainting, there are no deep reflexes, the pulse is barely palpable, blood pressure is low, breathing is shallow. The attack lasts several tens of seconds, and is then followed by a rapid and complete restoration of consciousness without amnesia.

Convulsive syncope is characterized by the addition of convulsions to the picture of syncope. In rare cases, drooling, involuntary urination and defecation are observed. The unconscious state sometimes lasts several minutes.

After fainting, general weakness, nausea, unpleasant feeling in a stomach.

The patient should be laid on his back with his head slightly lowered, the collar should be unbuttoned, fresh air should be provided, a cotton swab moistened with ammonia should be brought to the nose, and the face should be sprayed with cold water. For a more persistent fainting condition, 1 ml of a 10% solution of caffeine or 2 ml of cordiamine should be injected subcutaneously; ephedrine can be used - 1 ml of a 5% solution, mesaton - 1 ml of a 1% solution, norepinephrine - 1 ml of a 0.2% solution.

The patient should be examined by a doctor.

What are the hallmarks of a seizure in epilepsy?

One of the most common and dangerous types of convulsive conditions is a generalized convulsive seizure, which is observed in epilepsy. In most cases, patients with epilepsy, a few minutes before its onset, note the so-called aura (harbinger), which is manifested by increased irritability, palpitations, a feeling of heat, dizziness, chills, a feeling of fear, perception unpleasant odors, sounds, etc. Then the patient suddenly loses consciousness and falls. At the beginning of the first phase (in the first seconds) of the seizure, he often emits a loud cry.

When providing first aid to a patient, first of all, it is necessary to prevent possible bruises of the head, arms, legs during a fall and convulsions, for which a pillow is placed under the patient’s head, arms and legs are held. To prevent asphyxia, it is necessary to unfasten the collar. A hard object, such as a spoon wrapped in a napkin, must be inserted between the patient’s teeth to prevent tongue bite. To avoid inhaling saliva, the patient's head should be turned to the side.

A dangerous complication of epilepsy that threatens the patient’s life is status epilepticus, in which convulsive seizures follow one after another, so that consciousness does not clear. Status epilepticus is an indication for urgent hospitalization of the patient in the neurological department of the hospital.

For status epilepticus, emergency care consists of prescribing an enema with chloral hydrate (2.0 g per 50 ml of water), intravenous administration of 10 ml of a 25% solution of magnesium sulfate and 10 ml of a 40% glucose solution, intramuscular administration of 2-3 ml of a 2.5% solution aminazine, intravenous infusion of 20 mg of diazepam (seduxen), dissolved in 10 ml of 40% glucose solution. For ongoing seizures, 5-10 ml of a 10% hexenal solution is administered slowly intravenously. A spinal puncture is performed to remove 10-15 ml of solution.

A seizure in hysteria is significantly different from an epileptic seizure. It develops most often after any experiences associated with grief, resentment, fear, and, as a rule, in the presence of relatives or strangers. The patient may fall, but usually does not cause serious injury to himself, consciousness is preserved, there is no tongue biting or involuntary urination. The eyelids are tightly compressed, the eyeballs are turned upward. The reaction of the pupils to light is preserved. The patient responds correctly to painful stimuli. Convulsions are in the nature of purposeful movements (for example, the patient raises his arms, as if protecting his head from blows). Movements can be chaotic. The patient waves his arms and grimaces. The duration of a hysterical attack is 15-20 minutes, less often - several hours. The seizure ends quickly. The patient returns to his normal state and feels relief. There is no state of stupor or drowsiness. Unlike an epileptic seizure, a hysterical seizure never develops during sleep.

When providing assistance to a patient with a hysterical attack, it is necessary to remove all those present from the room where the patient is located. Talking to the patient calmly, but in an imperative tone, they convince him of the absence dangerous disease and inspire the idea of a speedy recovery. To relieve a hysterical attack, sedatives are widely used: sodium bromide, valerian tincture, motherwort herb decoction.

What are the general characteristics of poisonings?

Poisoning is a pathological condition caused by the effects of poisons on the body. The causes of poisoning can be poor-quality food products and poisonous plants, various chemicals used in everyday life and at work, medications, etc. Poisons have a local and general effect on the body, which depends on the nature of the poison and the route of its entry into the body.

For all acute poisonings, emergency care should be provided following goals: 1) maximum rapid elimination poison from the body; 2) neutralization of the poison remaining in the body with the help of antidotes (antidotes); 3) combating breathing and circulatory disorders.

If poison enters the mouth, immediate gastric lavage is necessary, which is carried out where the poisoning occurred (at home, at work); It is advisable to cleanse the intestines, for which they give a laxative and give an enema.

If poison gets on the skin or mucous membranes, the poison must be removed immediately mechanically. For detoxification, as prescribed by a doctor, solutions of glucose, sodium chloride, hemodez, polyglucin, etc. are administered subcutaneously and intravenously. If necessary, so-called forced diuresis is used: 3-5 liters of liquid and fast-acting diuretics are simultaneously administered. To neutralize the poison, specific antidotes are used (unithiol, methylene blue, etc.) depending on the nature of the poisoning. Oxygen is used to restore respiratory and circulatory function. cardiovascular drugs, respiratory analeptics, artificial respiration, including hardware.

What is the pathogenesis of the effect of current on the body and the causes of injury?

Electric shock with voltages above 50 V causes thermal and electrolytic effects. Most often, damage occurs as a result of non-compliance with safety precautions when working with electrical devices, both at home and at work.

First of all, the victim is released from contact with electric current (if this has not been done earlier). Turn off the power source, and if this is not possible, then remove the broken wire with a dry wooden stick. If the person providing assistance is wearing rubber boots and rubber gloves, then you can pull the victim away from the electrical wire. If breathing stops, artificial respiration is performed, cardiac and cardiovascular drugs are administered (0.1% adrenaline solution - 1 ml, cordiamine - 2 ml, 10% caffeine solution - 1 ml subcutaneously), drugs that stimulate breathing (1% lobeline solution - 1 ml intravenously slowly or intramuscularly). Apply a sterile bandage to the electrical burn wound.

The patient is transported on a stretcher to the burn or surgical department.

What are the causes of renal colic?

Renal colic develops when there is a sudden obstruction to the outflow of urine from the renal pelvis. Most often, renal colic develops as a result of the movement of a stone or the passage of a conglomerate of dense crystals through the ureter, as well as due to a violation of the patency of the ureter due to kinking or inflammatory processes.

The attack begins suddenly. Most often it is caused by physical stress, but it can also occur in the midst of complete rest, at night during sleep, often after drinking heavily. The pain is cutting with periods of calm and exacerbation. Patients behave restlessly, rushing about in bed in search of a position that would ease their suffering. An attack of renal colic often becomes protracted and, with short remissions, can last for several days in a row. As a rule, pain begins in the lumbar region and spreads to the hypochondrium and abdomen and, most importantly, along the ureter towards the bladder, scrotum in men, labia in women, and thighs. In many cases, the intensity of pain is greater in the abdomen or at the level of the genital organs than in the kidney area. The pain is usually accompanied by an increased urge to urinate and a cutting pain in the urethra.

Long-term renal colic may be accompanied by an increase in blood pressure, and with pyelonephritis - an increase in temperature.

First aid is usually limited to thermal procedures - a heating pad, a hot bath, which are supplemented by taking antispasmodic and painkillers from a home medicine cabinet (usually available to a patient with frequent attacks renal colic): Avisan - 0.5-1 g, cystenal - 10-20 drops, papaverine - 0.04 g, baralgin - 1 tablet. Atropine and narcotic analgesics are administered as prescribed by the doctor.

1. Evdokimov N.M. Providing first pre-medical aid.-M., 2001

2. Small medical encyclopedia vol. 1,2,3 M., 1986

3. First medical aid: reference book M., 2001

First aid requires medical personnel special approach. Algorithms for helping patients with common symptoms are available for download.

High-quality first aid in emergency conditions (EMC) is vital. Each condition and disease requires a special approach from medical staff.

Algorithms for helping patients with different symptoms are available for download.

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The main thing in the material

First aid for emergency conditions includes the provision of primary medical measures to patients whose condition threatens their health. These are exacerbations of various diseases, attacks, injuries and poisoning.

When providing first aid, conditions are distinguished that differ in the speed of their development in the patient’s body.

For example, some conditions can develop over several days (ketoacidotic coma in diabetes), while others develop rapidly (anaphylactic shock).

In all such emergency situations The task of doctors is to prevent the patient’s condition from worsening. This will improve the patient's situation.

The Ministry of Health has prepared amendments to the procedure for primary care for adults. Find out how to implement the requirements without delay from the magazine “Deputy Chief Physician”

When providing first aid, it is important to pay attention to the patient’s appearance. He can say more than a person's complaints spoken out loud. Many signs can be recognized by a person without medical education.

For example, this is a loss of consciousness, unusual color skin, change in voice, high temperature, atypical pulse, etc.

Based on these and other signs, it can be understood that a person requires assistance emergency assistance in emergency situations.

What is important to consider:

Help with NS has several important tasks:

eliminate a real threat to life, for which priority medical measures are taken;
ensure uninterrupted operation of the main systems of the human body;
minimize the risks of complications.

And finally, the physician must act effectively and accurately, so as not to cause harm to the patient’s health.

Help for various conditions and diseases

First aid includes a number of typical actions specified in first aid algorithms for various conditions and diseases.

Let's look at a few examples.

In case of dehydration (dehydration), the first actions of doctors include:
- intravenous administration of a special solution in an amount equal to 10% of the patient’s weight (trisol, quartasol, sodium chlorine solution, etc.);
- the speed of solution administration is observed. The first 2 liters - at a rate of up to 120 ml per minute, then - at a rate of 30-60 ml per minute;
- it is preferable to administer a quartasol solution.
In case of infectious-toxic shock, first aid for emergency conditions includes:
- oxygen inhalation;
- administration of prednisolone 60 mg with sodium chloride solution;
- Trental is administered intravenously or by drip;
- if these drugs are not available, 400 ml of hemodez, saline and glucose, etc. are administered intravenously.
- Then the hospital doctors work with him.
For acute neurological syndrome, emergency care includes:
- placing it in the most functionally advantageous position;
- psychomotor agitation is relieved, for which the patient is given diazepam, sodium hydroxybutyrate, prednisolone, oxygen inhalation, etc.;
- in the presence of hyperthermia - amidopyrine, reopirine, etc.;
- further assistance includes general and local physical hypothermia.

New rules for organizing palliative care were approved. In the article from the “Deputy Chief Physician” magazine, read how the responsibilities of medical staff were divided, what information and medical products now need to be provided to relatives, and how to refer patients to social service institutions. Attached are ready-made documents to organize the work.

How to provide first aid for anaphylactic shock

In emergency situations that develop rapidly, first aid is vital. For example, when anaphylactic shock Doctors have only a few minutes at their disposal.

9 emergency medical steps:

The entry of the suspected allergen into the human body must be stopped immediately. If it is a drug, its administration should be stopped immediately and ice should be applied to the injection site.
Medic evaluates general state, type of skin, breathing and blood circulation of the patient, airway patency.

An ambulance is immediately called, and if the patient is in a hospital, an intensive care team is called.

Epinephrine (adrenaline) is injected intramuscularly into the middle of the anterolateral surface of the thigh in a dosage appropriate to the person’s age and weight. Most patients respond to the first dose of adrenaline; if this does not happen, the procedure is repeated after 5-15 minutes.
Having laid the patient on his back, his legs should be raised and his head should be turned to the side so as to prevent tongue retraction and asphyxia. If the patient has dentures, they need to be removed.

At this stage, it is important to ensure that the patient breathes freely. The remaining actions are performed by ambulance doctors or resuscitation teams.

If there is difficulty breathing, a triple dose is performed according to P. Safar, and an endotracheal tube is inserted.

If swelling of the larynx or pharynx is observed, the trachea must be intubated. In severe cases, conicotomy is performed.

After normalization of breathing, an influx of fresh air into the room is organized. If this is not possible, pure oxygen is used.
Intravenous access should be established. As prescribed by the doctor, a sodium chloride solution is administered. Doctors must be prepared to perform emergency resuscitation.

Help with NS also includes performing chest compressions according to indications.

Readings such as respiratory rate, blood pressure, pulse and oxygenation levels are constantly monitored. So, if there is no special monitor, pulse and pressure must be monitored manually every 3-5 minutes.
The patient is transported to the intensive care unit.

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When does a clinic have the right to deviate from the standards? Four cases from practice and counterarguments for inspectors to avoid sanctions from Roszdravnadzor - in the magazine “Deputy Chief Physician”.

Help with accidents

Especially dangerous infection requires a special approach to first aid.

If disinfectants enter the body

if chloroactive drugs, for example, disinfectants, enter the patient’s stomach, immediate gastric lavage is necessary with a 2% hyposulfite solution;
in case of formaldehyde poisoning, a 3% solution of sodium acetate or carbonate is added to the washing water;
If the disinfectant gets into your eyes, you need to rinse them with a 2% solution baking soda or running water for 3-7 minutes;
if there is irritation, a solution of sodium sulfacyl 30% is instilled into the eyes;
If disinfectants come into contact with the skin, the affected area of the skin is washed with water. Then lubricated with emollient ointment;
if disinfectants pass through the respiratory tract, the victim is taken to fresh air or to a well-conditioned room. The nasopharynx and mouth are washed with water;
if these actions did not have a positive effect and the victim became worse, he is admitted to a hospital for further diagnosis.

As we can see, first aid and the actions of a physician vary depending on what kind of condition is suspected in the patient.

Below are algorithms for providing assistance with various diseases and states in the form of a memo for downloading.

First aid provided must be correct and timely. Our reminders reflect key points that are worth paying attention to.

For example, what mistakes should not be made when drowning, how to help with various injuries and carry out prompt localization.

Wounds: emergency care depending on type and location

First aid tasks

Closed pneumothorax, arterial hypertension, cholelithiasis, etc. – all these are conditions for which competent first aid is important.

The memos briefly describe the tasks of health workers, their primary actions, necessary medications and techniques.

GAPOU TO "Tobolsk Medical College named after V. Soldatov"

METHODOLOGICAL DEVELOPMENT

practical lesson

PM 04, PM 07 "Performing work in one or more worker professions, employee positions"

MDK "Technology for the provision of medical services"

TOPIC: "Providing first first aid under various conditions"

Teacher: Fedorova O.A.,

Cherkashina A.N., Zhelnina S.V.

Tobolsk, 2016

Glossary

A fracture is a complete or partial disruption of the integrity of a bone that occurs as a result of external mechanical action. A closed fracture, the integrity of the skin is not broken. An open fracture, the integrity of the skin above or near the site of deformation of the fracture is damaged. Wounds, damage to soft tissues in which the integrity of the skin is damaged. Scalped wounds, exfoliation of areas of the skin, subcutaneous tissue. Wounds, lacerations, defects. irregular shape with many angles, the wound along its length has different depths with damage to the skin, subcutaneous tissue, muscles Thermal burn is an injury that occurs under the influence of high temperature on the body tissues Fainting a sudden short-term loss of consciousness with a weakening of cardiac and respiratory systems Crampsinvoluntary muscle contractionElectrotrauma is damage caused by the action of electric current on the body. Poisoning is a pathological condition that develops when poison enters the body. Shock. The body's response to excessive exposure to damaging factors.

Relevance

Emergency conditions that threaten the life and health of the patient require urgent measures at all stages of medical care. These conditions arise due to the development of shock, acute blood loss, breathing disorders, circulatory disorders, comas that are caused by acute diseases internal organs, traumatic injuries, poisonings and accidents.

The most important place in providing assistance to those suddenly ill and injured as a result of natural and man-made emergencies in peacetime is to carry out adequate pre-hospital measures. As evidenced by the data of domestic and foreign specialists, a significant number of patients and victims of emergencies could have been saved subject to timely and effective provision of care at the prehospital stage.

Currently, the importance of first aid in the treatment of emergency conditions has increased enormously. The ability of nursing staff to assess the severity of the patient’s condition and identify priority problems is necessary to provide effective pre-medical care, which can greatly influence the further course and prognosis of the disease. A medical professional is required not only to have knowledge, but also to be able to quickly provide assistance, since confusion and inability to collect oneself can even aggravate the situation.

Thus, mastering the techniques of providing emergency medical care at the prehospital stage to sick and injured people, as well as improving practical skills, is an important and urgent task.

Modern principles of emergency medical care

In world practice, a universal scheme for providing assistance to victims at the prehospital stage has been adopted.

The main stages of this scheme are:

1.Immediate initiation of emergency life-sustaining measures in the event of emergency conditions.

2.Organizing the arrival of qualified specialists at the scene of the incident as soon as possible, performing certain emergency medical care measures during transport of the patient to the hospital.

.The fastest possible hospitalization to a specialized medical institution with a qualified medical staff and equipped with the necessary equipment.

Measures to be taken in case of emergency conditions

Treatment and evacuation measures carried out during the provision of emergency care should be divided into a number of interrelated stages - pre-hospital, hospital and first medical aid.

At the prehospital stage, first, pre-medical and first medical aid is provided.

The most important factor when providing emergency care is the time factor. Best results Treatment of victims and patients is achieved when the period from the moment of emergency condition to the time of provision of qualified assistance does not exceed 1 hour.

A preliminary assessment of the severity of the patient’s condition will allow you to avoid panic and fuss during subsequent actions, and will make it possible to take more balanced and rational decisions in extreme situations, as well as measures for emergency evacuation of the victim from the danger zone.

After this, it is necessary to begin identifying the signs of the most life-threatening conditions that can lead to the death of the victim in the coming minutes:

· clinical death;

· coma;

· arterial bleeding;

· neck injuries;

· chest injuries.

Those providing assistance to victims in an emergency must strictly adhere to the algorithm shown in Diagram 1.

Scheme 1. Procedure for providing assistance in case of emergency

Providing first aid in case of emergency

There are 4 basic principles of first aid that should be followed:

.Inspection of the scene of the incident. Ensure safety when providing assistance.

2.Initial examination of the victim and provision of first aid in life-threatening conditions.

.Call a doctor or ambulance.

.Secondary examination of the victim and, if necessary, assistance in identifying other injuries and illnesses.

Before providing assistance to victims, find out:

· Is the scene of the incident dangerous?

· What happened;

· Number of patients and victims;

· Are those around you able to help?

Of particular importance is anything that could threaten your safety and the safety of others: exposed electrical wires, falling debris, heavy traffic, fire, smoke, harmful fumes. If you are in any danger, do not approach the victim. Immediately call the appropriate rescue service or police for professional assistance.

Always look for other victims and, if necessary, ask others to assist you in providing assistance.

As soon as you approach the conscious victim, try to calm him down, then in a friendly tone:

· find out from the victim what happened;

· explain that you are a healthcare professional;

· offer assistance, obtain the victim’s consent to provide assistance;

· explain what action you are going to take.

Before you begin providing emergency medical care, you should obtain the victim's permission to do so. A conscious victim has the right to refuse your service. If he is unconscious, we can assume that you have obtained his consent to carry out emergency measures.

Bleeding

There are external and internal bleeding.

There are two types of bleeding: arterial and venous.

Arterial bleeding.The most dangerous bleeding is from injuries to large arteries - femoral, brachial, carotid. Death can occur in a matter of minutes.

Signs of arterial injury:arterial blood “gushes”, the color of the blood is bright red, the pulsation of the blood coincides with the heartbeat.

Signs of venous bleeding:venous blood flows out slowly, evenly, the blood is of a darker shade.

Methods to stop bleeding:

1.Finger pressure.

2.Tight bandage.

.Maximum limb flexion.

.Application of a tourniquet.

.Applying a clamp to a damaged vessel in a wound.

.Wound tamponade.

If possible, use a sterile dressing (or clean cloth) to apply a pressure bandage, apply it directly to the wound (to avoid eye injury and depression of the skull vault).

Any movement of the limb stimulates blood flow in it. In addition, when blood vessels are damaged, blood clotting processes are disrupted. Any movements cause additional damage to blood vessels. Splinting the limbs can reduce bleeding. In this case, air tires, or any type of tire, are ideal.

When applying a pressure bandage to a wound site does not reliably stop bleeding or there are multiple sources of bleeding supplied by a single artery, local compression may be effective.

It is necessary to apply a tourniquet only in extreme cases, when all other measures have not given the expected result.

Principles of applying a tourniquet:

§ I apply a tourniquet above the bleeding site and as close to it as possible over clothing or over several rounds of bandage;

§ the tourniquet should be tightened only until the peripheral pulse disappears and bleeding stops;

§ each subsequent tour of the tourniquet must partially cover the previous tour;

§ the tourniquet is applied for no more than 1 hour during a warm period, and no more than 0.5 hour during a cold period;

§ A note is inserted under the applied tourniquet indicating the time of application of the tourniquet;

§ after the bleeding has stopped, a sterile bandage is applied to the open wound, bandaged, the limb is fixed and the wounded person is sent to the next stage of medical care, i.e. evacuated.

A tourniquet can damage nerves and blood vessels and even lead to the loss of a limb. A loose tourniquet can stimulate more intense bleeding, since not arterial, but only venous blood flow stops. Use a tourniquet as a last resort for life-threatening conditions.

Fractures

Fracture -This is a complete or partial violation of the integrity of the bone that occurs due to external mechanical influence.

Types of fractures:

§ closed (the integrity of the skin is not compromised);

§ open (the integrity of the skin above or near the site of fracture deformation is compromised).

Signs of fractures:

§ deformation (change in shape);

§ local (local) soreness;

§ swelling of soft tissues over the fracture, hemorrhage in them;

§ for open fractures - laceration with visible bone fragments;

§ limb dysfunction;

§ pathological mobility.

§ checking airway patency, breathing and circulation;

§ imposing transport immobilization with service means;

§ aseptic dressing;

§ anti-shock measures;

§ transportation to health care facilities.

Signs of a mandibular fracture:

§ fracture of the lower jaw is more common due to impact;

§ besides common features fractures, characterized by displacement of teeth, disruption of normal occlusion, difficulty or impossibility chewing movements;

§ with double fractures of the lower jaw, the tongue may retract, which causes suffocation.

Emergency first aid:

§ check airway patency, breathing, blood circulation;

§ stop arterial bleeding temporarily by pressing the bleeding vessel;

§ secure the lower jaw with a sling bandage;

§ If your tongue sinks, making breathing difficult, fix your tongue.

Rib fractures.Rib fractures occur due to various mechanical impacts on the chest. There are single and multiple rib fractures.

Signs of a rib fracture:

§ rib fractures are accompanied by sharp local pain when palpating, breathing, coughing;

§ the victim spares the damaged part of the chest; breathing on this side is shallow;

§ in case of damage to the pleura and lung tissue air from the lungs enters the subcutaneous tissue, which looks like swelling on the damaged side of the chest; subcutaneous tissue crunches when touched (subcutaneous emphysema).

Emergency first aid:

§ As you exhale, apply a circular pressure bandage to the chest;

§ With injuries to the chest organs, call an ambulance to hospitalize the victim in a hospital specializing in chest injuries.

Wounds

Wounds are damage to soft tissues in which the integrity of the skin is compromised. With deep wounds, subcutaneous tissue, muscles, nerve trunks and blood vessels are injured.

Types of woundsThere are cut, chopped, stab and gunshot wounds.

In appearance, wounds are:

§ scalped - areas of skin and subcutaneous tissue peel off;

§ torn - irregularly shaped defects with many angles are observed on the skin, subcutaneous tissue and muscle, the wound has different depths along its length. The wound may contain dust, dirt, soil, and pieces of clothing.

Emergency first aid:

§ check ABC (airway, breathing, circulation);

§ During the primary care period, simply rinse the wound with saline or clean water and apply a clean bandage and elevate the limb.

Emergency first aid for open wounds:

§ stop the main bleeding;

§ remove dirt, splinters and debris by irrigating the wound with clean water, saline solution;

§ apply an aseptic dressing;

§ for extensive wounds, immobilize the limb

Lacerationsare divided into:

superficial (including only the skin);

deep (involve underlying tissues and structures).

Puncture woundsusually not accompanied by massive external bleeding, but be alert to the possibility of internal bleeding or tissue damage.

Emergency first aid:

§ do not remove deeply stuck objects;

§ stop the bleeding;

§ stabilize foreign body using a bulky bandage and, as necessary, immobilization with splints.

§ apply an aseptic bandage.

Thermal lesions

Burns

Thermal burn -This is an injury that occurs when body tissue is exposed to high temperature.

The depth of the lesion is divided into 4 degrees:

1st degree -hyperemia and swelling of the skin, accompanied by burning pain;

2nd degree -hyperemia and swelling of the skin with detachment of the epidermis and the formation of blisters filled with clear liquid; severe pain is observed in the first 2 days;

3A, 3B degrees -damaged, in addition to the dermis, subcutaneous tissue and muscle, necrotic scabs form; pain and tactile sensitivity are absent;

4th degree -necrosis of the skin and underlying tissues up to bone tissue, the scab is dense, thick, sometimes black until charred.

In addition to the depth of the lesion, the area of the lesion is also important, which can be determined using the “rule of palm” or “rule of nine”.

According to the “rule of nine,” the area of the skin of the head and neck is equal to 9% of the body surface; breasts - 9%; abdomen - 9%; backs - 9%; lower back and buttocks - 9%; hands - 9% each; hips - 9% each; legs and feet - 9% each; perineum and external genitalia - 1%.

According to the "rule of the palm", the area of an adult's palm is approximately 1% of the body surface.

Emergency first aid:

§ termination of the thermal factor;

§ cooling the burned surface with water for 10 minutes;

§ applying an aseptic dressing to the burn surface;

§ warm drink;

§ evacuation to the nearest health facility in a lying position.

Frostbite

Cold affects the body local action causing frostbite individual parts body, and general, which leads to general cooling (freezing).

Frostbite is divided into 4 degrees according to the depth of damage:

With general cooling, compensatory reactions initially develop (constriction of peripheral vessels, changes in breathing, the appearance of tremors). As it deepens, a phase of decompensation begins, accompanied by gradual depression of the central nervous system, weakening of cardiac activity and respiration.

A mild degree is characterized by a decrease in temperature to 33-35 C, chills, pallor of the skin, and the appearance of " goose bumps"Speech is slow, weakness, drowsiness, and bradycardia are noted.

The average degree of cooling (stuporous stage) is characterized by a decrease in body temperature to 29-27 C. The skin is cold, pale or bluish. There is drowsiness, depression of consciousness, and difficulty moving. The pulse is slowed to 52-32 beats per minute, breathing is rare, blood pressure is reduced to 80-60 mm. rt. Art.

A severe degree of cooling is characterized by a lack of consciousness, muscle rigidity, and convulsive contractions of the masticatory muscles. Pulse 34-32 beats. per minute Blood pressure is reduced or undetectable, breathing is rare and shallow, the pupils are constricted. When decreasing rectal temperature before 24-20 C death occurs.

Emergency first aid:

§ stop the cooling effect;

§ after removing damp clothing, cover the victim warmly and give him a hot drink;

§ provide thermal insulation of cooled limb segments;

§ evacuate the victim to the nearest health facility in a prone position.

Sun and heat stroke

Symptoms of solar and heatstroke close and appear suddenly.

Sunstrokeoccurs on a clear summer day with prolonged exposure to the sun without a hat. Tinnitus, dizziness, nausea, vomiting appear, body temperature rises to 38-39 C, sweating, redness of the facial skin are noted, pulse and breathing increase sharply. In severe cases, severe agitation, loss of consciousness, and even death can occur.

Heatstrokeoccurs after physical activity high temperature external environment. The skin becomes moist and sometimes turns pale. Body temperature rises. The victim may complain of weakness, fatigue, nausea, and headache. Tachycardia and orthostatic hypertension may occur.

Emergency first aid:

§ Move the victim to a cooler place and give him a moderate amount of liquid to drink;

§ put cold on the head, on the heart area;

§ lay the victim on his back;

§ If the victim's blood pressure has dropped, elevate the lower limbs.

Acute vascular insufficiency

Fainting- sudden short-term loss of consciousness with weakening of the cardiac and respiratory systems. Fainting is based on cerebral hypoxia, which is caused by a transient disturbance of cerebral blood flow.

In patients with fainting, three periods are distinguished: prefainting, actual fainting, and postfainting.

Presyncopemanifested by a feeling of lightheadedness, darkening of the eyes, ringing in the ears, weakness, dizziness, nausea, sweating, numbness of the lips, fingertips, pallor of the skin. Duration from several seconds to 1 minute.

While faintingloss of consciousness, a sharp decrease in muscle tone, and shallow breathing are noted. The pulse is labile, weak, arrhythmic. With a relatively long-term disturbance of cerebral circulation, there may be clinically tonic convulsions and involuntary urination. Fainting lasts up to 1 minute, sometimes more.

Post-syncopelasts from a few seconds to 1 minute and ends full restoration consciousness.

Emergency first aid:

§ lay the patient on his back with his head slightly lowered or raise the patient's legs to a height of 60-70 cm in relation to the horizontal surface;

§ loosen tight clothing;

§ provide access to fresh air;

§ bring a cotton swab moistened with ammonia to your nose;

§ splash his face with cold water or pat his cheeks, rub his chest;

§ Make sure that the patient sits for 5-10 minutes after fainting;

If you suspect organic cause fainting requires hospitalization.

Convulsions

Cramps -involuntary muscle contraction. Spasmodic movements can be widespread and involve many muscle groups of the body (generalized spasms) or localized to a specific muscle group of the body or limb (localized spasms).

Generalized seizurescan be stable, lasting a relatively long period of time - tens of seconds, minutes (tonic), or rapid, often alternating states of contraction and relaxation (clonic).

Localized seizurescan also be clonic and tonic.

Generalized tonic spasms involve the muscles of the arms, legs, torso, neck, face and sometimes the respiratory tract. The arms are often in a state of flexion, the legs are usually extended, the muscles are tense, the torso is elongated, the head is thrown back or turned to the side, the teeth are clenched tightly. Consciousness may be lost or retained.

Generalized tonic convulsions are more often a manifestation of epilepsy, but can also be observed with hysteria, rabies, tetanus, eclampsia, cerebrovascular accident, infections and intoxications in children.

Emergency first aid:

§ protect the patient from bruises;

§ free him from restrictive clothing;

emergency medical care

§ free the patient’s oral cavity from foreign objects (food, removable dentures);

§ To prevent tongue bite, insert the corner of a rolled towel between your molars.

Strike by lightning

Lightning usually strikes people who are near open place during a thunderstorm. The damaging effect of atmospheric electricity is primarily due to very high voltage (up to 1,000,0000 W) and discharge power; in addition, the victim can receive traumatic lesions as a result of the action of an air blast wave. Severe burns (up to IV degree) are also possible, since the temperature in the area of the so-called lightning channel can exceed 25,000 C. Despite the short duration of exposure, the victim’s condition is usually serious, which is primarily due to damage to the central and peripheral nervous system.

Symptoms:loss of consciousness from several minutes to several days, conical convulsions; after restoration of consciousness, anxiety, agitation, disorientation, pain, delirium; hallucinations, paresis of limbs, hemi- and paraparesis, headache, pain and pain in the eyes, tinnitus, burns of the eyelids and eyeball, clouding of the cornea and lens, “lightning sign” on the skin.

Emergency first aid:

§ restoration and maintenance of airway patency and artificial ventilation of the lungs;

§ indirect massage hearts;

§ hospitalization, transporting the victim on a stretcher (preferably in a lateral position due to the risk of vomiting).

Electric shock

Most dangerous manifestation electrical injury is clinical death, which is characterized by stopping breathing and heartbeat.

First aid for electrical injury:

§ release the victim from contact with the electrode;

§ preparing the victim for resuscitation measures;

§ performing mechanical ventilation in parallel with closed massage hearts.

Bee, wasp, bumblebee stings

The venom of these insects contains biological amines. Insect bites are very painful local reaction it manifests itself in the form of swelling and inflammation. Swelling is more pronounced when biting the face and lips. Single bites do not work general reaction body, but stings of more than 5 bees are toxic, with chills, nausea, dizziness, and dry mouth.

Emergency first aid:

· remove the sting from the wound with tweezers;

The most important thing before the doctors arrive is to stop the influence of factors that worsen the well-being of the injured person. This step involves eliminating life-threatening processes, for example: stopping bleeding, overcoming asphyxia.

Determine the actual status of the patient and the nature of the disease. The following aspects will help with this:

what are the blood pressure values?
are bleeding wounds visible?
the patient has a reaction of the pupils to light;
has your heart rate changed?
respiratory functions are preserved or not;
how adequately a person perceives what is happening;
whether the victim is conscious or not;
if necessary, ensuring respiratory functions by accessing fresh air and ensuring that there are no foreign objects in the air ducts;
carrying out non-invasive ventilation (artificial respiration using the “mouth to mouth” method);
performing indirect (closed) in the absence of a pulse.

Quite often, the preservation of health and human life depends on the timely provision of high-quality first aid. In emergency situations, all victims, regardless of the type of illness, need competent emergency actions before the arrival of the medical team.

First aid for emergency conditions cannot always be offered by qualified doctors or paramedics. Every modern person must have the skills of pre-medical measures and know the symptoms of common diseases: the result depends on the quality and timeliness of measures, the level of knowledge, and the skills of witnesses to critical situations.

ABC Algorithm

Emergency pre-medical actions involve performing a set of simple medical and preventive measures directly at or near the site of the tragedy. First aid for emergency conditions, regardless of the nature of the illness or received, has a similar algorithm. The essence of the measures depends on the nature of the symptoms shown by the affected person (for example: loss of consciousness) and on the suspected causes emergency(for example: hypertensive crisis with arterial hypertension). Rehabilitation activities within the framework of first aid in emergency conditions, they are carried out according to uniform principles - the ABC algorithm: these are the first English letters denoting:

Air (air);
Breathing (breathing);
Circulation (blood circulation).