Cheat sheet: Algorithm for providing emergency care for cardiac diseases and poisoning. Emergency and emergency medical care Providing emergency first aid
Foreign bodies
Foreign body of the external ear, as a rule, does not pose a danger to the patient and does not require urgent removal. Inept removal attempts are dangerous foreign body. It is forbidden to use tweezers to remove round objects; tweezers can only be used to remove an elongated foreign body (a match). For living foreign bodies, it is recommended to infuse heated sunflower or petroleum jelly into the external auditory canal, which leads to the death of the insect. Before removing swollen foreign bodies (peas, beans), a few drops of heated 70° ethyl alcohol are first poured into the ear to dehydrate them. Removal of a foreign body is done by washing the ear with warm water or a disinfectant solution (potassium permanganate, furatsilin) from a Janet syringe or rubber balloon. A stream of liquid is directed along the superoposterior wall of the outer ear canal, the foreign body is removed along with the liquid. While washing the ear, the head should be well fixed. Ear lavage is contraindicated in case of perforation of the eardrum, complete obstruction of the ear canal by a foreign body, or sharp-shaped foreign objects (metal shavings).
When hit foreign body in the nasal passage close the opposite nostril and ask the child, straining very hard, to blow his nose. If a foreign body remains, only a doctor can remove it from the nasal cavity. Repeated attempts to remove a foreign body and instrumental interventions at the prehospital stage are contraindicated, as they can lead to the pushing of foreign objects into the underlying parts of the respiratory tract, blocking them and causing suffocation.
When hit foreign body in the lower respiratory tract baby early age turn upside down, holding the legs, make shaking movements, trying to remove the foreign object. For older children, if they are unable to get rid of a foreign body when coughing, perform one of the following methods:
The child is placed with his stomach on the adult’s bent knee, the victim’s head is lowered down and the hand is lightly tapped on the back;
The patient is grabbed with the left hand at the level of the costal arch and 3-4 blows are applied with the palm of the right hand to the spine between the shoulder blades;
The adult clasps the child from the back with both arms, clasps his hands and places them slightly below the costal arch, then sharply presses the victim to himself, trying to put maximum pressure on the epigastric region;
If the patient is unconscious, he is turned over on his side and 3-4 sharp and strong blows are performed with the palm of the hand on the spine between the shoulder blades.
In any case, you must call a doctor.
Stenosing laryngotracheitis
Emergency first aid for stenotic laryngotracheitis is aimed at restoring airway patency. They are trying to remove or reduce the symptoms of laryngeal stenosis using distracting procedures. Conduct alkaline or steam inhalations, warm foot and hand baths (temperature from 37°C with a gradual increase to 40°C), hot water or semi-alcohol compresses on the neck and calf muscles. If there is no increase in body temperature, a general hot bath taking all precautions. Give warm alkaline drink in small portions. Provide access to fresh air.
Artificial ventilation
The most important condition for successful artificial respiration is ensuring the patency of the airways. The child is placed on his back, the patient’s neck, chest and abdomen are freed from constricting clothing, and the collar and belt are unfastened. The oral cavity is freed from saliva, mucus, and vomit. Then one hand is placed on the parietal area of the victim, the second hand is placed under the neck and the child’s head is tilted back as much as possible. If the patient's jaws are tightly closed, the mouth is opened, pushing forward lower jaw and pressing your index fingers on your cheekbones.
When using the method "mouth to nose" Cover the child’s mouth tightly with your palm and, after a deep breath, exhale vigorously, wrapping your lips around the victim’s nose. When using the method "mouth to mouth" They pinch the patient’s nose with their thumb and forefinger, inhale the air deeply and, tightly pressing their mouth to the child’s mouth, exhale into the victim’s mouth, having previously covered it with gauze or a handkerchief. Then the patient’s mouth and nose are opened slightly, after which the patient exhales passively. Artificial respiration is performed for newborns at a frequency of 40 breaths per minute, for young children - 30, for older children - 20.
During artificial ventilation of the lungs Holger-Nielsen method The child is placed on his stomach, they press with their hands on the patient’s shoulder blades (exhale), then they stretch out the victim’s arms (inhale). Artificial respiration Sylvester's way performed with the child in a supine position, the victim’s arms are crossed on the chest and pressed on the sternum (exhalation), then the patient’s arms are straightened (inhalation).
Indirect cardiac massage
The patient is placed on a hard surface, removed from clothing, and the belt is unfastened. Straightened in elbow joints with your hands, press on the lower third of the child’s sternum (two transverse fingers above the xiphoid process). Squeezing is performed with the palmar part of the hand, placing one palm on top of the other, raising the fingers of both hands. For newborn babies, indirect cardiac massage is performed with two thumbs of both hands or the index and middle finger of one hand. Pressure on the sternum is carried out with quick rhythmic pushes. The compression force should ensure a displacement of the sternum towards the spine in newborns by 1-2 cm, in young children - 3-4 cm, in older children - 4-5 cm. The frequency of pressure corresponds to the age-related heart rate.
Pulmonary-cardiac resuscitation
Stages of pulmonary-cardiac resuscitation;
Stage I – restoration of airway patency;
Stage II – artificial ventilation;
Stage III – indirect cardiac massage.
If pulmonary-cardiac resuscitation is performed by one person, then after 15 compressions on the chest, he performs 2 artificial breaths. If there are two resuscitators, the ratio of pulmonary ventilation/cardiac massage is 1:5.
The criteria for the effectiveness of pulmonary-cardiac resuscitation are:
The appearance of pupil reaction to light (constriction);
Restoration of pulsation in the carotid, radial, femoral arteries;
Promotion blood pressure;
The appearance of independent respiratory movements;
Restoring the normal color of the skin and mucous membranes;
Return of consciousness.
Fainting
When fainting, the child is given a horizontal position with his head slightly lowered and his legs raised in order to improve blood supply to the brain. Free from restrictive clothing, unfasten the collar and belt. Provide access to fresh air, open windows and doors wide, or take the child out into the open air. Face sprayed cold water, pat on the cheeks. Give a cotton swab moistened with ammonia to smell.
Collapse
Measures to provide emergency care for collapse before the doctor arrives include placing the child in a horizontal position on his back with raised lower limbs, wrapping him in a warm blanket, and warming him with heating pads.
Paroxysmal tachycardia
To relieve an attack of paroxysmal tachycardia, techniques are used that cause irritation of the vagus nerve. The most effective methods are straining the child at the height of a deep breath (Valsava maneuver), influencing the sinocarotid zone, pressing on the eyeballs (Aschner reflex), and artificially inducing vomiting.
Internal bleeding
Patients with hemoptysis and pulmonary hemorrhage They are given a semi-sitting position with their legs down, they are prohibited from moving, talking, or straining. They remove clothing that restricts breathing and provide an influx of fresh air by opening the windows wide. The child is recommended to swallow small pieces of ice and drink cold water in small portions. Apply an ice pack to the chest.
At gastrointestinal bleeding Strict bed rest is prescribed, food and liquid intake is prohibited. An ice pack is placed on the abdominal area. Constant monitoring of pulse rate and filling, and blood pressure levels are carried out.
Urgent hospitalization is indicated.
External bleeding
Child with nosebleeds give a semi-sitting position. It is forbidden to blow your nose. A cotton ball moistened with a 3% solution of hydrogen peroxide or a hemostatic sponge is inserted into the vestibule of the nose. The wing of the nose is pressed against the nasal septum. Ice or gauze soaked in cold water is placed on the back of the head and bridge of the nose.
The main urgent action for external traumatic bleeding is a temporary stop of bleeding. Arterial bleeding from the vessels of the upper and lower extremities is stopped in two stages: first, the artery is pressed above the site of injury to the bony protrusion, then a standard rubber or improvised tourniquet is applied.
To compress the brachial artery, place the fist in the armpit and press the arm to the body. Temporary stopping of bleeding from the arteries of the forearm is achieved by placing a cushion (bandage package) in the elbow bend and bending the arm to the maximum at the elbow joint. If the femoral artery is affected, press with a fist on the upper third of the thigh in the area of the inguinal (pupart) ligament. Pressing the arteries of the lower leg and foot is carried out by inserting a cushion (bandage package) into the popliteal area and bending the leg at the knee joint to the maximum.
After pressing the arteries, they begin to apply a hemostatic tourniquet, which is placed over clothing or a towel, a scarf, or a piece of gauze. The tourniquet is brought under the limb above the wound site, stretched strongly and, without reducing the tension, tightened around the limb and fixed. If the tourniquet is applied correctly, bleeding from the wound stops, the pulse in the radial artery or dorsal artery of the foot disappears, and the distal parts of the limb turn pale. It should be remembered that excessive tightening of the tourniquet, especially on the shoulder, can cause paralysis of the peripheral parts of the limb due to damage to the nerve trunks. A note is placed under the tourniquet indicating the time the tourniquet will be applied. After 20-30 minutes, the pressure of the tourniquet can be released. The tourniquet, applied to a soft pad, should not be on the limb for more than 1 hour.
Arterial bleeding from the arteries of the hand and foot does not require the application of a tourniquet. It is enough to tightly bandage a tight roll of sterile napkins (a pack of sterile bandage) to the wound site and give the limb an elevated position. A tourniquet is used only for extensive multiple wounds and crush injuries of the hand and foot. Injuries to the digital arteries are stopped with a tight pressure bandage.
Arterial bleeding in the scalp area ( temporal artery), on the neck (carotid artery) and torso (subclavian and iliac arteries) are stopped by tight wound tamponade. Using tweezers or a clamp, the wound is tightly packed with napkins, on top of which you can apply an unwrapped bandage from a sterile package and bandage it as tightly as possible.
Venous and capillary bleeding is stopped by applying a tight pressure bandage. If a large main vein is damaged, a tight tamponade of the wound can be performed or a hemostatic tourniquet can be applied.
Acute urinary retention
Emergency care for acute urinary retention involves prompt removal of urine from Bladder. Independent urination is facilitated by the sound of running water from a tap and irrigation of the genitals with warm water. If there are no contraindications, place a warm heating pad on the pubic area or place the child in a warm bath. If these measures are ineffective, they resort to catheterization of the bladder.
Hyperthermia
During the period of maximum increase in body temperature, the child should be given plenty of water often: liquid is given in the form of fruit juices, fruit drinks, and mineral waters. When body temperature rises above 37°C for each degree, additional fluid administration is required at the rate of 10 ml per 1 kg of the child’s body weight. Cracks on the lips are lubricated with Vaseline or other oil. Carry out thorough oral care.
With the “pale” type of fever, the child experiences chills, pale skin, and cold extremities. First of all, the patient is warmed up, covered with a warm blanket, heating pads are applied, and a warm drink is given.
The “red” type of fever is characterized by a feeling of heat, the skin is warm, moist, and a blush on the cheeks. In such cases, to increase heat transfer, physical methods of reducing body temperature are used: the child is undressed, air baths are given, the skin is wiped with a semi-alcohol solution or a solution of table vinegar, the head and liver area is cooled with an ice pack or a cold compress.
Overheating (heatstroke) may occur in a child who is in a poorly ventilated room with high air temperature and humidity, during intense physical work in stuffy rooms. Warm clothing, poor drinking habits, and overwork contribute to overheating. In infants, heat stroke can occur when wrapped in warm blankets or when a crib (or stroller) is near a central heating radiator or stove.
Signs of heat stroke depend on the presence and degree of hyperthermia. With mild overheating, the condition is satisfactory. Body temperature is not elevated. Patients complain of headache, weakness, dizziness, tinnitus, and thirst. The skin is moist. Breathing and pulse are slightly increased, blood pressure is within normal limits.
If there is a significant degree of overheating, severe headache, nausea and vomiting often occur. A short-term loss of consciousness is possible. The skin is moist. Breathing and pulse are increased, blood pressure is increased. Body temperature reaches 39-40°C.
Severe overheating is characterized by an increase in body temperature to 40°C and above. Patients are excited, delirium, psychomotor agitation are possible, contact with them is difficult. Infants often experience diarrhea, vomiting, sharpened facial features, a rapid deterioration in their general condition, and possible convulsions and coma. A characteristic sign of severe overheating is the cessation of sweating, the skin is moist and dry. Breathing is frequent and shallow. Possible respiratory arrest. The pulse is sharply increased, blood pressure is reduced.
When signs appear heatstroke the patient is urgently taken to a cool place and provided with access to fresh air. The child is undressed, given a cold drink, and a cold compress is placed on the head. In more severe cases, wrapping sheets soaked in cold water, dousing with cool water, applying ice to the head and groin area, and hospitalization are indicated.
Sunstroke occurs in children exposed to the sun for a long time. Currently, the concepts of “heat” and “sunstroke” are not distinguished, since in both cases changes occur due to the general overheating of the body.
Emergency care for sunstroke is similar to the care provided to patients with heatstroke. In severe cases, urgent hospitalization is indicated.
Cold damage found in various climatic zones. This problem is especially relevant for the regions of the Far North and Siberia, however, cold injury can also be observed in areas with relatively high average annual temperatures. Cold can have a general and local effect on the child’s body. General action cold leads to the development general cooling(freezing), and local action causes frostbite.
General cooling or freezing– a state of the human body in which, under the influence of unfavorable external conditions, body temperature drops to +35°C and below. At the same time, against the background of a decrease in body temperature (hypothermia), functional disorders develop in the body with a sharp suppression of all vital functions, up to complete extinction.
All victims, regardless of the degree of general cooling, should be hospitalized. It should be borne in mind that victims with mild degrees of freezing may refuse hospitalization because they do not adequately assess their condition. The main principle of treatment for general cooling is warming. At the prehospital stage, first of all, further cooling of the victim is prevented. To do this, the child is immediately brought into a warm room or car, wet clothes are removed, wrapped in a blanket, covered with heating pads, and given hot sweet tea. Under no circumstances should the victim be left outside, rubbed with snow, or drink alcoholic beverages. In the absence of signs of breathing and blood circulation at the prehospital stage, the entire complex of cardiopulmonary resuscitation is carried out while warming the victim.
Frostbite occurs with local prolonged exposure low temperatures. Exposed parts of the body (nose, ears) and extremities are most often affected. A circulatory disorder occurs, first of the skin, and then of the underlying tissues, and necrosis develops. Depending on the severity of the lesion, there are four degrees of frostbite. I degree is characterized by the appearance of edema and hyperemia with a bluish tint. At stage II, blisters filled with light exudate form. III degree of frostbite is characterized by the appearance of blisters with hemorrhagic contents. With IV degree frostbite, all layers of skin, soft tissue and bones die.
The injured child is brought into a warm room, shoes and mittens are removed. A heat-insulating aseptic bandage is applied to the affected area of the nose and ear. The frostbitten limb is first rubbed with a dry cloth, then placed in a basin with warm (32-34°C) water. Within 10 minutes, the temperature is brought to 40-45°C. If the pain that occurs during warming up quickly passes, the fingers return to their normal appearance or are slightly swollen, sensitivity is restored - the limb is wiped dry, wiped with a semi-alcohol solution, put on cotton socks and warm woolen socks or mittens on top. If warming up is accompanied by increasing pain, the fingers remain pale and cold, which indicates a deep degree of frostbite - the affected child is hospitalized.
Poisoning
Providing first aid to children with acute poisoning is aimed at accelerating the elimination of toxic substances from the body. For this purpose, vomiting is stimulated, the stomach and intestines are washed, and diuresis is forced. Stimulation of vomiting is carried out only in children who are fully conscious. After drinking the maximum possible amount of water, irritate the back wall of the pharynx with a finger or spoon. Stimulation of vomiting is facilitated by drinking a warm solution table salt(1 tablespoon per glass of water). The procedure is repeated until the impurities completely disappear and clean water appears. Gastric lavage is the main measure for removing toxic substances and should be performed as early as possible. When ingesting strong acids (sulfuric, hydrochloric, nitric, oxalic, acetic), gastric lavage is carried out with cold water using a probe lubricated with vaseline or vegetable oil. In case of poisoning with alkalis (ammonia, ammonia, bleaching powder etc.) the stomach is washed with cold water or a weak solution (1-2%) of acetic or citric acid through a probe lubricated with vaseline or vegetable oil, after cleansing, enveloping agents (mucous decoctions, milk) or sodium bicarbonate are introduced into the stomach cavity. To cleanse the intestines, use a saline laxative and perform cleansing enemas. Forcing diuresis at the prehospital stage is achieved by prescribing plenty of fluids.
In order to change the metabolism of a toxic substance in the body and reduce its toxicity, it is used antidote therapy. Atropine is used as an antidote for poisoning with organophosphorus compounds (chlorophos, dichlorvos, karbofos, etc.), for poisoning with atropine (belladonna, henbane, belladonna) - pilocarpine, for poisoning with copper and its compounds (copper sulfate) - unithiol.
In case of poisoning by inhaled toxic substances (gasoline, kerosene), carbon monoxide (carbon monoxide), the child is taken out of the room, access to fresh air is provided, and oxygen therapy is administered.
Emergency care for poisoning with poisonous mushrooms involves washing the stomach and intestines with the introduction of a saline laxative and a suspension of enterosorbent. In case of fly agaric poisoning, atropine is additionally administered.
Burns
At thermal skin burns it is necessary to stop exposure to the thermal agent. When clothing catches fire, the fastest and most effective means of extinguishing is to pour water on the victim or throw a tarpaulin, blanket, etc. over the victim. Clothes from damaged areas of the body are carefully removed (cut with scissors without touching the wound surface). Parts of clothing tightly adhering to the burnt skin are carefully cut off. Cool the burned area with cold running water or use an ice pack. The bubbles should not be opened or cut off. Ointments, powders, oil solutions. Aseptic dry or wet-dry dressings are applied to the burn surface. If there is no dressing material, the affected area of skin is wrapped in a clean cloth. Victims with deep burns are hospitalized.
At chemical skin burns caused by acids and alkalis, the most universal and most effective means of providing first aid is prolonged rinsing of the burned area with copious amounts of running water. Quickly remove clothing soaked in the chemical agent, continuing to wash the burned surface of the skin. Contact with water is contraindicated for burns caused by quicklime and organic compounds aluminum In case of alkali burns, the burn wounds are washed with a weak solution of acetic or citric acid. If the damaging agent was acid, then a weak solution of sodium bicarbonate is used for washing.
Electrical injury
First aid for electric shock is to eliminate the damaging effects of the current. Urgently turn off the switch, cut, chop or discard the wires, using objects with a wooden handle. When freeing a child from exposure to electric current, you should observe your own safety, do not touch the exposed parts of the victim’s body, you must use rubber gloves or dry rags wrapped around your hands, rubber shoes, and stand on a wooden surface or car tire. If the child does not have breathing or cardiac activity, they immediately begin performing artificial ventilation and chest compressions. A sterile bandage is applied to the electrical burn wound.
Drowning
The injured child is removed from the water. The success of resuscitation measures largely depends on their correct and timely implementation. It is advisable that they begin not on the shore, but already on the water, while towing the child to the shore. Even several artificial breaths carried out during this period significantly increase the likelihood of subsequent revival of the drowned person.
More advanced assistance to the victim can be provided in a boat (dinghy, cutter) or on the shore. If the child is unconscious, but breathing and cardiac activity are preserved, they are limited to freeing the victim from restrictive clothing and using ammonia. The absence of spontaneous breathing and cardiac activity requires immediate artificial ventilation and chest compressions. First, the oral cavity is cleaned of foam, mucus, sand, and silt. To remove water that has entered the respiratory tract, the child is placed on his stomach in a bent position. knee joint the thigh of the person providing assistance, the head is lowered down and, supporting the victim’s head with one hand, the other hand is lightly struck several times between the shoulder blades. Or the lateral surfaces of the chest are compressed with sharp jerking movements (for 10-15 seconds), after which the child is turned onto his back again. These preparatory measures are carried out as quickly as possible, then artificial respiration and chest compressions begin.
Poisonous snake bites
When bitten by poisonous snakes, the first drops of blood are squeezed out of the wound, then cold is applied to the bite site. It is necessary that the affected limb remain motionless, since movements enhance lymphatic drainage and accelerate the entry of poison into the general circulation. The victim is kept at rest, the affected limb is fixed with a splint or improvised means. You should not burn the bite site, inject it with any drugs, bandage the affected limb above the bite site, suck out the poison, etc. Urgent hospitalization to the nearest hospital is indicated.
Insect bites
For insect bites (bees, wasps, bumblebees), remove the insect sting from the wound using tweezers (if not, use your fingers). The bite site is moistened with a semi-alcohol solution and cold is applied. Drug therapy is carried out as prescribed by a doctor.
CONTROL QUESTIONS
What is the help when a foreign body gets into the nasal passages and respiratory tract?
What should be the first aid for laryngeal stenosis?
What methods of artificial ventilation are there?
What measures should be taken in case of cardiac arrest?
Determine the sequence of actions when performing pulmonary-cardiac resuscitation.
What activities can help bring a child out of fainting?
What emergency care is provided for poisoning?
What measures are taken for acute urinary retention?
What methods of temporarily stopping external bleeding do you know?
What are the ways to reduce body temperature?
What is the help for frostbite?
What first aid is provided for thermal burns?
How to help a child with an electrical injury?
What measures should be taken in case of drowning?
What is the help for insect and poisonous snake bites?
Conditions requiring emergency assistance, are called urgent. First aid in these cases consists of a timely and accurate assessment of the victim’s condition, giving him an optimal position and performing the necessary priority actions to ensure patency of the airway, breathing and blood circulation.
FAINTING
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 diseases.
Fainting can be due to various reasons:
1. Unexpected sharp pain, fear, nervous shock.
They can call instant decrease 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 may be reduced due to indoor exposure large quantity people, 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 care. 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 assistance is needed.
SHOCK
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. A decrease in blood volume leads to a drop in 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 like the brain, kidneys, etc. The sweat glands also increase their 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 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 - extensive allergic reaction immediate type, which 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 vital organs.
Sometimes death can occur later due to changes in the kidneys, gastrointestinal tract, heart, brain and other organs.
Symptoms and signs of anaphylactic shock:
Reaction - the victim feels anxiety, a 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.
Attack bronchial asthma 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. 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 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 returns 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) is an attack of acute pain in the chest caused by transient coronary circulatory insufficiency, acute ischemia myocardium.
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 may occur as a result of psychoemotional stress, which may lead to a spasm of pathologically unchanged coronary arteries hearts.
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 - main sign pain syndrome- his paroxysmal behavior. 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 into the left half of the chest, into the left arm to the fingers, left shoulder blade and shoulder, neck, and lower jaw is typical.
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 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.
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 blockage of a coronary artery by a thrombus - a blood clot that forms at the site of narrowing of the vessel due to atherosclerosis. As a result, a more or less extensive area of the heart “turns 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 mellitus and other metabolic diseases;
Genetic predisposition;
Influence environment 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, the pain spreads to the right of the sternum, sometimes involves 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
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 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 blood vessel or heart cavity formed intravitally; embolus is a substrate circulating in the blood that is not found 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 stare, repetitive or jerking movements. individual muscles(head, lips, hands, 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.
A grand mal seizure is a sudden loss of 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. The total duration of 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 - reduced content blood glucose Hypoglycemia can occur in a diabetic patient.
Diabetes is a disease in which the body does not produce enough of the hormone insulin, which regulates the amount of sugar in the blood.
If the brain does not receive enough sugar, then just 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.
Introduction
Anaphylactic shock
Arterial hypotension
Angina pectoris
Myocardial infarction
Bronchial asthma
Comatose states
Hepatic coma. Vomiting "Coffee Grounds"
Convulsions
Poisoning
Electric shock
Renal colic
List of sources used
Urgent state (from Latin urgens, emergency) is a condition that poses a threat to the life of the patient/injured and requires urgent (within minutes-hours, not days) medical and evacuation measures.
Primary requirements
1. Preparedness to provide emergency medical care in the proper amount.
Availability of equipment, tools and medicines. Medical personnel must master the necessary manipulations, be able to work with equipment, know the doses, indications and contraindications for the use of basic medicines. You need to become familiar with the operation of the equipment and read reference books in advance, and not in an emergency situation.
2. Simultaneity of diagnostic and therapeutic measures.
For example, a patient with a coma of unknown origin is sequentially injected intravenously with therapeutic and diagnostic purposes: thiamine, glucose and naloxone.
Glucose - initial dose 80 ml of 40% solution. If the cause of the comatose state is hypoglycemic coma, the patient will regain consciousness. In all other cases, glucose will be absorbed as an energy product.
Thiamine - 100 mg (2 ml of 5% thiamine chloride solution) for the prevention of acute Wernicke encephalopathy (a potentially fatal complication of alcoholic coma).
Naloxone - 0.01 mg/kg in case of opiate poisoning.
3. Focus primarily on the clinical situation
In most cases, lack of time and insufficient information about the patient do not allow us to formulate a nosological diagnosis and treatment is essentially symptomatic and/or syndromic. It is important to keep pre-worked algorithms in your head and be able to pay attention to the most important details necessary for diagnosis and emergency care.
4. Remember your own safety
The patient may be infected (HIV, hepatitis, tuberculosis, etc.). The place where emergency care is provided is dangerous (toxic substances, radiation, criminal conflicts, etc.) Misbehavior or errors in emergency care may result in legal action.
What are the main causes of anaphylactic shock?
This is a life-threatening acute manifestation of an allergic reaction. More often it develops in response to parenteral administration of drugs, such as penicillin, sulfonamides, serums, vaccines, protein preparations, radiocontrast agents, etc., and also appears during provocative tests with pollen and, less often, food allergens. Anaphylactic shock may occur from insect bites.
The clinical picture of anaphylactic shock is characterized by rapid development - a few seconds or minutes after contact with the allergen. There is depression of consciousness, a drop in blood pressure, convulsions, and involuntary urination. The fulminant course of anaphylactic shock ends in death. For most, the disease begins with the appearance of a feeling of heat, skin hyperemia, fear of death, excitement or, conversely, depression, headache, chest pain, suffocation. Sometimes swelling of the larynx develops like Quincke's edema with stridorous breathing, skin itching, rashes, rhinorrhea, and dry hacking cough appear. Blood pressure drops sharply, the pulse becomes threadlike, and hemorrhagic syndrome with petechial rashes may be expressed.
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 corglycone - 1 ml of 0.06% solution in isotonic solution sodium chloride, Lasix (furosemide) 40-60 mg intravenously in a rapid stream in an isotonic sodium chloride solution. If an allergic reaction has developed to 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, there is a dull, pressing headache, 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. In this case, skin irritation causes a reflex expansion of the 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 administration of nitroglycerin (0.0005 g per tablet or 2-3 drops of a 1% alcohol solution) does not relieve the pain, it is necessary to administer promedol (1 ml of a 2% solution), pantopon (1 ml of a 2% solution) or morphine (1 cl 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 is an acute vascular failure, which is manifested by a sharp decrease in blood pressure and peripheral circulation disorder. Most common cause 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 an unconscious state with profound impairment of reflexes and lack of response to stimuli.
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 an increasing exacerbation of the symptoms of the underlying disease, signs of damage to the central nervous system appear in the form of stupor, lethargy, indifference, confusion with periodic clearings. However, during this period, patients retain the ability to respond to severe irritation, with a delay, monosyllabically, but still answer a loudly asked question, they retain their 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 cardiac and respiratory systems. Fainting is a mild form of acute cerebrovascular insufficiency 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, prolonged stay in a stuffy room, intoxication and infectious diseases.
Degree of expression fainting may be different. 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 a more severe case of fainting, complete loss of consciousness occurs with loss of muscle tone, and the patient slowly subsides. 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, and an unpleasant feeling in the stomach persist.
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 of a dangerous disease and instill in him 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 may 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 t. 1,2,3 M., 1986
3. First medical aid: reference book M., 2001
41. Principles of first aid in emergency situations.
First aid– this is a set of urgent measures aimed at restoring or preserving the life and health of the victim in the event of injury or sudden illness, carried out directly at the scene of the incident as soon as possible after the injury (defeat). It turns out to be, as a rule, non-medical workers, but people who were nearby at the time of the incident. There are four basic rules for providing first aid in emergency situations: inspection of the scene of the incident, initial examination of the victim, calling an ambulance, and secondary examination of the victim.
1) Inspection of the scene of the incident. When inspecting the scene of the incident, pay attention to what may threaten the life of the victim, your safety and the safety of others: exposed electrical wires, falling debris, intense traffic, fire, smoke, harmful fumes, adverse weather conditions, depth of water or fast current and much more. If you are in any danger, do not approach the victim. Call an ambulance or emergency services immediately. Try to determine the nature of the incident. Pay attention to details that might clue you in to the type of injury you sustained. They are especially important if the victim is unconscious. See if there are other victims at the scene. When approaching the victim, try to calm him down.
2) Initial examination of the victim. During the initial examination, it is necessary to check for signs of life of the victim. Signs of life include the presence of a pulse, breathing, pupil reaction to light and level of consciousness. If you have breathing problems, artificial ventilation is necessary; in the absence of cardiac activity - cardiopulmonary resuscitation.
Carrying out artificial pulmonary ventilation (ALV). Artificial respiration is carried out in in cases where the victim does not breathe or breathes very poorly (rarely, convulsively, as if with a sob), and also if his breathing is constantly deteriorating. Most effective way artificial respiration is the “mouth to mouth” or “mouth to nose” method, since this ensures that a sufficient volume of air enters the lungs (up to 1000-1500 ml per breath); The air exhaled by a person is physiologically suitable for breathing by the victim. Air is blown through gauze, a handkerchief, other loose fabric or a special “air duct”. This method of artificial respiration allows you to easily control the flow of air into the victim’s lungs by expanding the chest after inflation and lowering it as a result of passive exhalation. To carry out artificial respiration, the victim should be laid on his back, unbuttoning clothing that restricts breathing. The complex of resuscitation measures should begin with checking and, if necessary, restoring airway patency. If the victim is unconscious, the airways may be closed by a sunken tongue, there may be vomit in the mouth, dislodged dentures, etc., which must be quickly removed with a finger wrapped in a scarf or the edge of clothing. First you need to make sure that there are no contraindications to throwing your head back - severe neck trauma, fractures of the cervical vertebrae. In the absence of contraindications, checking the patency of the respiratory tract, as well as mechanical ventilation, are carried out using the head tilt method. The person providing assistance is located on the side of the victim’s head, puts one hand under his neck, and with the palm of the other hand presses on his forehead, throwing his head back as much as possible. In this case, the root of the tongue rises and clears the entrance to the larynx, and the victim’s mouth opens. The resuscitator leans towards the victim’s face, completely tightly covers the victim’s open mouth with his lips and exhales vigorously, blowing air into his mouth with some effort; at the same time, he covers the victim’s nose with his cheek or the fingers of his hand on the forehead. In this case, it is necessary to observe the victim’s chest, which rises. After the chest rises, the injection (infusion) of air is stopped, and the victim exhales passively, the duration of which should be approximately twice as long as the inhalation. If the victim’s pulse is well determined and only artificial respiration is necessary, then the interval between artificial breaths should be 5 seconds (12 respiratory cycles per minute). With effective artificial respiration, in addition to expansion of the chest, there may be pinking of the skin and mucous membranes, as well as the emergence of the victim from an unconscious state and the appearance of independent breathing. If the victim’s jaws are clenched tightly and it is impossible to open his mouth, artificial respiration should be performed “mouth to nose.” When the first weak breaths appear, artificial inhalation should be timed to coincide with the moment the victim begins to inhale spontaneously. Artificial respiration is stopped after the victim has restored sufficiently deep and rhythmic spontaneous breathing.
Performing cardiopulmonary resuscitation (CPR). External cardiac massage is an essential component of resuscitation; it provides artificial contractions of the heart muscle and restoration of blood circulation. When performing external cardiac massage, the resuscitator selects a position to the left or right of the victim and determines the point of application of pressure. To do this, he feels the lower end of the sternum and, stepping back two transverse fingers higher, sets the palmar surface of the hand perpendicular to the sternum. The second hand is located on top, at a right angle . It is very important that your fingers do not touch your chest. This promotes the effectiveness of cardiac massage and significantly reduces the risk of rib fractures. Indirect massage should begin with a jerky compression of the sternum and its displacement towards the spine by 4...5 cm, lasting 0.5 s and quick relaxation of the hands, without lifting them from the sternum. When performing external cardiac massage, a common cause of failure is long pauses between pressures. External cardiac massage is combined with artificial respiration. This may be carried out by one or two resuscitators.
During resuscitation by one resuscitator after every two quick injections of air into the lungs, it is necessary to do 15 compressions of the sternum (ratio 2:15) with an interval of 1 second between inhalation and cardiac massage.
With two people involved in resuscitation the “breathing-massage” ratio is 1:5, i.e. after one deep insufflation, apply five pressures on the chest. During artificial inspiration, do not apply pressure to the sternum to massage the heart, i.e. It is necessary to strictly alternate resuscitation operations. With correct resuscitation actions, the skin turns pink, the pupils constrict, and spontaneous breathing is restored. Pulse on carotid arteries during the massage it should be clearly palpable if it is detected by another person. After restoration of cardiac activity with a well-determined natural (without massage) pulse, cardiac massage is immediately stopped, continuing artificial respiration with weak independent breathing of the victim and trying to ensure that natural and artificial breaths coincide. When full spontaneous breathing is restored, artificial respiration is also stopped. If your efforts are successful and the unconscious victim begins to detect breathing and a pulse, do not leave him lying on his back, unless he has a neck or back injury. Turn the victim onto their side so that their airway is open.
3) Call an ambulance. « Ambulance" must be called in any situation. Especially in cases of: unconsciousness or with a changing level of consciousness; breathing problems (difficulty or lack of breathing); persistent pain or pressure in the chest; lack of pulse; heavy bleeding; severe abdominal pain; vomiting with blood or bloody discharge (with urine, sputum, etc.); poisoning; seizures; severe headache or slurred speech; head, neck or back injuries; likelihood of bone fracture; sudden movement disorders.
4) Secondary examination of the victim. After calling an ambulance and if you are confident that the victim does not have conditions that threaten his life, they proceed to a secondary examination. Interview the victim and those present again about what happened, and conduct a general examination. The importance of a secondary examination is to detect problems that do not directly pose a threat to the life of the victim, but can have serious consequences (bleeding, fractures, etc.) if they are left without attention and first aid. After completing the secondary examination of the victim and providing first aid, continue to observe signs of life until the ambulance arrives.
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Definition. Emergency conditions are pathological changes in the body that lead to a sharp deterioration in health, threaten the patient’s life and require emergency treatment measures. The following emergency conditions are distinguished:
Directly life threatening
Not life-threatening, but without assistance the threat will be real
Conditions in which failure to provide emergency assistance will lead to permanent changes in the body
Situations in which it is necessary to quickly alleviate the patient’s condition
Situations requiring medical intervention in the interests of others due to inappropriate behavior of the patient
restoration of external respiration function
relief of collapse, shock of any etiology
relief of convulsive syndrome
prevention and treatment of cerebral edema
CARDIOPULMONARY RESUSCITATION.
Definition. Cardiopulmonary resuscitation (CPR) is a set of measures aimed at restoring lost or severely impaired vital functions of the body in patients in a state of clinical death.
Basic 3 techniques of CPR according to P. Safar, "ABC rule":
A ire way open - ensure airway patency;
B reath for victim – start artificial respiration;
C irculation his blood - restore blood circulation.
A- is carried out triple trick according to Safar - throwing back the head, extreme forward displacement of the lower jaw and opening the patient’s mouth.
Give the patient the appropriate position: lay him on a hard surface, placing a cushion of clothing on his back under his shoulder blades. Throw your head back as far as possible
Open your mouth and look around oral cavity. In case of convulsive compression of the masticatory muscles, use a spatula to open it. Clear the oral cavity of mucus and vomit with a handkerchief wrapped around your index finger. If the tongue is stuck, turn it out with the same finger.
Rice. Preparing for artificial respiration: push the lower jaw forward (a), then move the fingers to the chin and, pulling it down, open the mouth; with the second hand placed on the forehead, tilt the head back (b).
Rice. Restoration of airway patency.
a- opening the mouth: 1-crossed fingers, 2-grasping the lower jaw, 3-using a spacer, 4-triple technique. b- cleaning the oral cavity: 1 - using a finger, 2 - using suction. (Fig. by Moroz F.K.)
B - artificial pulmonary ventilation (ALV). Ventilation is the injection of air or an oxygen-enriched mixture into the patient’s lungs without/with the use of special devices. Each insufflation should take 1–2 seconds, and the respiratory rate should be 12–16 per minute. mechanical ventilation at the stage of pre-medical care is carried out "mouth to mouth" or “mouth to nose” with exhaled air. In this case, the effectiveness of inhalation is judged by the rise of the chest and passive exhalation of air. The emergency team usually uses either an airway, face mask and ambu bag, or tracheal intubation and ambu bag.
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Rice. Mouth-to-mouth ventilation. |
Stand on the right side, holding the victim’s head in an tilted position with your left hand, and at the same time cover the nasal passages with your fingers. Right hand The lower jaw should be pushed forward and upward. In this case, the following manipulation is very important: a) hold the jaw by the zygomatic arches with the thumb and middle finger; b) index finger open the oral cavity slightly; c) the tips of the ring and little fingers (4th and 5th fingers) control the pulse in the carotid artery. |
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Take a deep breath, cover the victim’s mouth with your lips and inhale. Cover your mouth with any clean cloth first for hygienic purposes. At the moment of insufflation, control the rise of the chest When signs of spontaneous breathing appear in the victim, mechanical ventilation is not stopped immediately, continuing until the number of spontaneous breaths corresponds to 12-15 per minute. At the same time, if possible, synchronize the rhythm of inhalations with the recovery breathing of the victim. Mouth-to-nose ventilation is indicated when assisting a drowning person, if resuscitation is carried out directly in water, for fractures of the cervical spine (tilting the head back is contraindicated). Ventilation using an Ambu bag is indicated if assistance is provided “mouth to mouth” or “mouth to nose” Rice. Ventilation using simple devices. a – through an S-shaped air duct; b- using a mask and an Ambu bag; c- through an endotracheal tube; d- percutaneous transglottic ventilation. (Fig. by Moroz F.K.) |
Rice. Mouth-to-nose ventilation | |||
C - indirect cardiac massage.
The patient lies on his back on a hard surface. The person providing assistance stands on the side of the victim and places the hand of one hand on the lower middle third of the sternum, and the hand of the second on top, across the first to increase pressure.
the doctor should stand quite high (on a chair, stool, stand, if the patient is lying on a high bed or on the operating table), as if hanging with his body over the victim and putting pressure on the sternum not only with the force of his hands, but also with the weight of his body.
The resuscitator's shoulders should be directly above the palms, and the elbows should not be bent. With rhythmic pushes of the proximal part of the hand, pressure is applied to the sternum in order to shift it towards the spine by approximately 4-5 cm. The pressure should be such that one of the team members can clearly detect an artificial pulse wave on the carotid or femoral artery.
The number of chest compressions should be 100 per minute
The ratio of chest compressions to artificial respiration in adults is 30: 2 whether one or two people perform CPR.
In children, the ratio is 15:2 if CPR is performed by 2 people, 30:2 if it is performed by 1 person.
simultaneously with the start of mechanical ventilation and massage, intravenous jet: every 3-5 minutes 1 mg of adrenaline or 2-3 ml endotracheally; atropine – 3 mg intravenously as a bolus once.
Rice. Position of the patient and those providing assistance during indirect massage hearts.
ECG- asystole ( isoline on ECG)
intravenously 1 ml of 0.1% solution of epinephrine (adrenaline), repeated intravenously after 3 - 4 minutes;
intravenously atropine 0.1% solution - 1 ml (1 mg) + 10 ml of 0.9% sodium chloride solution after 3 - 5 minutes (until an effect is obtained or a total dose of 0.04 mg/kg);
Sodium bicarbonate 4% - 100 ml is administered only after 20-25 minutes of CPR.
if asystole persists - immediate percutaneous, transesophageal or endocardial temporary electrocardiostimulation.
ECG- ventricular fibrillation (ECG – randomly located waves of different amplitudes)
electrical defibrillation (ED). Discharges of 200, 200 and 360 J (4500 and 7000 V) are recommended. All subsequent discharges - 360 J.
In case of ventricular fibrillation after the 3rd shock, cordarone in an initial dose of 300 mg + 20 ml of 0.9% sodium chloride solution or 5% glucose solution, repeated - 150 mg (maximum up to 2 g). In the absence of cordarone, administer lidocaine– 1-1.5 mg/kg every 3-5 minutes up to a total dose of 3 mg/kg.
Magnesium sulfate – 1-2 g intravenously for 1-2 minutes, repeat after 5-10 minutes.
EMERGENCY CARE FOR ANAPHYLACTIC SHOCK.
Definition. Anaphylactic shock is an immediate systemic allergic reaction to repeated introduction of an allergen as a result of rapid massive immunoglobulin-E-mediated release of mediators from tissue basophils (mast cells) and basophilic granulocytes of peripheral blood (R.I. Shvets, E.A. Vogel, 2010 .).
Provoking factors:
taking medications: penicillin, sulfonamides, streptomycin, tetracycline, nitrofuran derivatives, amidopyrine, aminophylline, aminophylline, diaphylline, barbiturates, anthelmintics, thiamine hydrochloride, glucocorticosteroids, novocaine, sodium thiopental, diazepam, radiopaque and iodine-containing substances.
Administration of blood products.
Food products: chicken eggs, coffee, cocoa, chocolate, strawberries, wild strawberries, crayfish, fish, milk, alcoholic drinks.
Administration of vaccines and serums.
Insect bites (wasps, bees, mosquitoes)
Pollen allergens.
Chemicals (cosmetics, detergents).
Local manifestations: edema, hyperemia, hypersalivation, necrosis
Systemic manifestations: shock, bronchospasm, disseminated intravascular coagulation, intestinal disorders
Urgent Care:
Stop contact with allergens: stop parenteral administration of the drug; remove the insect sting from the wound with an injection needle (removal with tweezers or fingers is undesirable, since it is possible to squeeze out the remaining poison from the reservoir of the insect's poisonous gland remaining on the sting) Apply ice or a heating pad with cold water to the injection site for 15 minutes.
Lay the patient down (head higher than legs), turn the head to the side, extend the lower jaw, and if there are removable dentures, remove them.
If necessary, perform CPR, tracheal intubation; for laryngeal edema - tracheostomy.
Indications for mechanical ventilation for anaphylactic shock:
Swelling of the larynx and trachea with obstruction of the airways;
Intractable arterial hypotension;
Impaired consciousness;
Persistent bronchospasm;
Pulmonary edema;
Development of coagulopathic bleeding.
Immediate tracheal intubation and mechanical ventilation are performed in case of loss of consciousness and a decrease in systolic blood pressure below 70 mm Hg. Art., in case of stridor.
The appearance of stridor indicates obstruction of the lumen of the upper respiratory tract by more than 70–80%, and therefore the patient’s trachea should be intubated with a tube of the maximum possible diameter.
Drug therapy:
Provide intravenous access into two veins and begin transfusion of 0.9% - 1,000 ml of sodium chloride solution, stabizol - 500 ml, polyglucin - 400 ml
Epinephrine (adrenaline) 0.1% - 0.1 -0.5 ml intramuscularly, if necessary, repeat after 5 -20 minutes.
For anaphylactic shock medium degree severity, fractional (bolus) administration of 1-2 ml of the mixture (1 ml -0.1% adrenaline + 10 ml 0.9% sodium chloride solution) is indicated every 5-10 minutes until hemodynamic stabilization.
Epinephrine is administered intratracheally in the presence of an endotracheal tube in the trachea - as an alternative to the intravenous or intracardiac routes of administration (simultaneously 2-3 ml diluted with 6-10 ml in isotonic sodium chloride solution).
prednisolone intravenously 75-100 mg - 600 mg (1 ml = 30 mg prednisolone), dexamethasone - 4-20 mg (1 ml = 4 mg), hydrocortisone - 150-300 mg (if intravenous administration is not possible - intramuscularly).
for generalized urticaria or when urticaria is combined with Quincke's edema - diprospan (betamethasone) - 1-2 ml intramuscularly.
for Quincke's edema, a combination of prednisolone and antihistamines new generation: Semprex, Telfast, Clarifer, Allertek.
intravenous membrane stabilizers: ascorbic acid 500 mg/day (8–10 ml of 5% solution or 4–5 ml of 10% solution), troxevasin 0.5 g/day (5 ml of 10% solution), sodium ethamsylate 750 mg/day (1 ml = 125 mg), initial dose - 500 mg, then 250 mg every 8 hours.
intravenously aminophylline 2.4% 10–20 ml, no-spa 2 ml, alupent (brikanil) 0.05% 1–2 ml (drip); isadrin 0.5% 2 ml subcutaneously.
with persistent hypotension: dopmin 400 mg + 500 ml of 5% glucose solution intravenously (the dose is titrated until the level is reached systolic pressure 90 mmHg) and is prescribed only after replenishment of the circulating blood volume.
for persistent bronchospasm, 2 ml (2.5 mg) of salbutamol or berodual (fenoterol 50 mg, iproaropium bromide 20 mg), preferably via nebulizer
for bradycardia, atropine 0.5 ml -0.1% solution subcutaneously or 0.5 -1 ml intravenously.
It is advisable to administer antihistamines to the patient only after stabilization of blood pressure, since their effect can aggravate hypotension: diphenhydramine 1% 5 ml or suprastin 2% 2–4 ml, or tavegil 6 ml intramuscularly, cimetidine 200–400 mg (10% 2–4 ml) intravenously, famotidine 20 mg every 12 hours (0.02 g of dry powder diluted in 5 ml of solvent) intravenously, pipolfen 2.5% 2–4 ml subcutaneously.
Hospitalization in the department intensive care/ allergology for generalized urticaria, Quincke's edema.
EMERGENCY CARE FOR ACUTE CARDIOVASCULAR FAILURE: CARDIOGENIC SHOCK, syncope, collapse
Definition. Acute cardiovascular failure is a pathological condition caused by the inadequacy of cardiac output to the metabolic needs of the body. May be due to 3 reasons or a combination of them:
Sudden decrease in myocardial contractility
Sudden decrease in blood volume
Sudden drop in vascular tone.
Causes: arterial hypertension, acquired and congenital heart defects, pulmonary embolism, myocardial infarction, myocarditis, cardiosclerosis, myocardiopathy. Conventionally, cardiovascular failure is divided into cardiac and vascular.
Acute vascular insufficiency is characteristic of conditions such as fainting, collapse, shock.
Cardiogenic shock: emergency care.
Definition. Cardiogenic shock is an emergency condition resulting from acute circulatory failure, which develops due to a deterioration in myocardial contractility, the pumping function of the heart, or a disturbance in the rhythm of its activity. Causes: myocardial infarction, acute myocarditis, heart injury, heart disease.
The clinical picture of shock is determined by its shape and severity. There are 3 main forms: reflex (pain), arrhythmogenic, true.
Reflex cardiogenic shock – a complication of myocardial infarction that occurs at the height of a painful attack. More often occurs with lower-posterior localization of the infarction in middle-aged men. Hemodynamics return to normal after the pain attack is relieved.
Arrhythmogenic cardiogenic shock – a consequence of cardiac arrhythmia, most often against the background of ventricular tachycardia > 150 per minute, fibrillation of pre-series, ventricular fibrillation.
True cardiogenic shock - a consequence of impaired myocardial contractility. The most severe form of shock due to extensive necrosis of the left ventricle.
Adynamia, retardation or short-term psychomotor agitation
The face is pale with a grayish-ashy tint, skin covering marble color
Cold sticky sweat
Acrocyanosis, cold extremities, collapsed veins
The main symptom is sharp drop GARDEN< 70 мм. рт. ст.
Tachycardia, shortness of breath, signs of pulmonary edema
Oligouria
0.25 mg acetylsalicylic acid chew in the mouth
Lay the patient down with the lower limbs elevated;
oxygen therapy with 100% oxygen.
For an anginal attack: 1 ml of 1% morphine solution or 1-2 ml of 0.005% fentanyl solution.
Heparin 10,000 -15,000 units + 20 ml of 0.9% sodium chloride intravenously.
400 ml of 0.9% sodium chloride solution or 5% glucose solution intravenously over 10 minutes;
intravenous bolus solutions of polyglucin, reformran, stabizol, rheopolyglucin until blood pressure stabilizes (SBP 110 mm Hg)
At heart rate > 150/min. – absolute indication for EIT, heart rate<50 в мин абсолютное показание к ЭКС.
No blood pressure stabilization: dopmin 200 mg intravenously + 400 ml of 5% glucose solution, administration rate from 10 drops per minute until SBP reaches at least 100 mm Hg. Art.
If there is no effect: norepinephrine hydrotartrate 4 mg in 200 ml of 5% glucose solution intravenously, gradually increasing the infusion rate from 0.5 mcg/min to a SBP of 90 mm Hg. Art.
if SBP is more than 90 mm Hg: 250 mg of dobutamine solution + 200 ml of 0.9% sodium chloride intravenously.
Admission to the intensive care unit/intensive care unit
First aid for fainting.
Definition. Fainting is an acute vascular insufficiency with a sudden short-term loss of consciousness caused by an acute lack of blood flow to the brain. Causes: negative emotions (stress), pain, sudden change in body position (orthostatic) with a disorder of the nervous regulation of vascular tone.
Tinnitus, general weakness, dizziness, pale face
Loss of consciousness, the patient falls
Pale skin, cold sweat
Thready pulse, decreased blood pressure, cold extremities
Duration of fainting from several minutes to 10-30 minutes
Place the patient with his head bowed and legs raised, free from tight clothing
Give a sniff of 10% aqueous ammonia solution (ammonia)
Midodrine (gutron) 5 mg orally (in tablets or 14 drops of 1% solution), maximum dose - 30 mg / day or intramuscularly or intravenously 5 mg
Mezaton (phenylephrine) intravenously slowly 0.1 -0.5 ml 1% solution + 40 ml 0.9% sodium chloride solution
For bradycardia and cardiac arrest, atropine sulfate 0.5 - 1 mg intravenous bolus
If breathing and circulation stop - CPR
Emergency care for collapse.
Definition. Collapse is an acute vascular insufficiency that occurs as a result of inhibition of the sympathetic nervous system and increased tone of the vagus nerve, which is accompanied by dilation of arterioles and a violation of the relationship between the capacity of the vascular bed and the blood volume. As a result, venous return, cardiac output, and cerebral blood flow are reduced.
Causes: pain or anticipation of it, sudden change in body position (orthostatic), overdose of antiarrhythmic drugs, ganglion blockers, local anesthetics (Novocaine). Antiarrhythmic drugs.
General weakness, dizziness, tinnitus, yawning, nausea, vomiting
Pale skin, cold clammy sweat
Decreased blood pressure (systolic blood pressure less than 70 mm Hg), bradycardia
Possible loss of consciousness
Horizontal position with legs raised
1 ml 25% cordiamin solution, 1-2 ml 10% caffeine solution
0.2 ml of 1% mezaton solution or 0.5 - 1 ml of 0.1% epinephrine solution
For prolonged collapse: 3-5 mg/kg hydrocortisone or 0.5–1 mg/kg prednisolone
For severe bradycardia: 1 ml -0.15 atropine sulfate solution
200 -400 ml polyglucin / rheopolyglucin