First aid for emergency conditions caused by diseases. Emergencies and emergency medical care

Clinical manifestations

First aid

With a neurovegetative form of a crisis, the sequence of actions:

1) inject 4–6 ml of a 1% solution of furosemide intravenously;

2) inject 6–8 ml of 0.5% dibazol solution dissolved in 10–20 ml of 5% glucose solution or 0.9% sodium chloride solution intravenously;

3) inject 1 ml of a 0.01% solution of clonidine in the same dilution intravenously;

4) inject 1–2 ml of a 0.25% solution of droperidol in the same dilution intravenously.

With a water-salt (edematous) form of a crisis:

1) inject 2–6 ml of a 1% solution of furosemide intravenously once;

2) inject 10–20 ml of a 25% solution of magnesium sulfate intravenously.

With a convulsive form of a crisis:

1) inject intravenously 2-6 ml of 0.5% diazepam solution diluted in 10 ml of 5% glucose solution or 0.9% sodium chloride solution;

2) antihypertensive drugs and diuretics - according to indications.

In a crisis associated with a sudden cancellation (cessation) of antihypertensive drugs: inject 1 ml of a 0.01% solution of clonidine diluted in 10-20 ml of a 5% glucose solution or 0.9% sodium chloride solution.

Notes

1. Drugs should be administered sequentially, under the control of blood pressure;

2. In the absence of a hypotensive effect within 20–30 minutes, in the presence of acute cerebrovascular accident, cardiac asthma, angina pectoris, hospitalization in a multidisciplinary hospital is required.

angina pectoris

Clinical manifestations s - m. Nursing in therapy.

First aid

1) stop physical activity;

2) put the patient on his back and with his legs down;

3) give him a tablet of nitroglycerin or validol under the tongue. If the pain in the heart does not stop, repeat the intake of nitroglycerin every 5 minutes (2-3 times). If there is no improvement, call a doctor. Before he arrives, proceed to the next stage;

4) in the absence of nitroglycerin, 1 tablet of nifedipine (10 mg) or molsidomine (2 mg) can be given under the tongue to the patient;

5) give an aspirin tablet (325 or 500 mg) to drink;

6) offer the patient to drink hot water in small sips or put a mustard plaster on the heart area;

7) in the absence of the effect of therapy, hospitalization of the patient is indicated.

myocardial infarction

Clinical manifestations- see Nursing in Therapy.

First aid

1) lay or seat the patient, unfasten the belt and collar, provide access to fresh air, complete physical and emotional peace;

2) with systolic blood pressure not less than 100 mm Hg. Art. and heart rate greater than 50 in 1 min. give a nitroglycerin tablet under the tongue with an interval of 5 minutes. (but not more than 3 times);

3) give an aspirin tablet (325 or 500 mg) to drink;

4) give a propranolol 10–40 mg tablet under the tongue;

5) enter intramuscularly: 1 ml of a 2% solution of promedol + 2 ml of a 50% solution of analgin + 1 ml of a 2% solution of diphenhydramine + 0.5 ml of a 1% solution of atropine sulfate;

6) with systolic blood pressure less than 100 mm Hg. Art. it is necessary to intravenously inject 60 mg of prednisolone diluted with 10 ml of saline;

7) inject heparin 20,000 IU intravenously, and then 5,000 IU subcutaneously into the area around the navel;

8) the patient should be transported to the hospital in the supine position on a stretcher.

Pulmonary edema

Clinical manifestations

It is necessary to differentiate pulmonary edema from cardiac asthma.

1. Clinical manifestations of cardiac asthma:

1) frequent shallow breathing;

2) expiration is not difficult;

3) orthopnea position;

4) during auscultation, dry or wheezing rales.

2. Clinical manifestations of alveolar pulmonary edema:

1) suffocation, bubbling breath;

2) orthopnea;

3) pallor, cyanosis of the skin, moisture of the skin;

4) tachycardia;

5) allocation of a large amount of frothy, sometimes blood-stained sputum.

First aid

1) give the patient a sitting position, apply tourniquets or cuffs from the tonometer to the lower limbs. Reassure the patient, provide fresh air;

2) inject 1 ml of a 1% solution of morphine hydrochloride dissolved in 1 ml of physiological saline or 5 ml of a 10% glucose solution;

3) give nitroglycerin 0.5 mg sublingually every 15–20 minutes. (up to 3 times);

4) under the control of blood pressure, inject 40–80 mg of furosemide intravenously;

5) in case of high blood pressure, inject intravenously 1-2 ml of a 5% solution of pentamin, dissolved in 20 ml of saline, 3-5 ml with an interval of 5 minutes; 1 ml of a 0.01% solution of clonidine dissolved in 20 ml of saline;

6) establish oxygen therapy - inhalation of humidified oxygen using a mask or nasal catheter;

7) inhalation of oxygen moistened with 33% ethyl alcohol, or inject 2 ml of 33% ethanol solution intravenously;

8) inject 60–90 mg of prednisolone intravenously;

9) in the absence of the effect of therapy, an increase in pulmonary edema, a fall in blood pressure, artificial ventilation of the lungs is indicated;

10) hospitalize the patient.

Fainting can occur during a long stay in a stuffy room due to a lack of oxygen, in the presence of tight, breath-restricting clothing (corset) in a healthy person. Repeated fainting is a reason for a visit to the doctor in order to exclude a serious pathology.

Fainting

Clinical manifestations

1. Short-term loss of consciousness (for 10–30 s.).

2. There are no indications of diseases of the cardiovascular, respiratory systems, gastrointestinal tract in the anamnesis, the obstetric and gynecological anamnesis is not burdened.

First aid

1) give the patient's body a horizontal position (without a pillow) with slightly raised legs;

2) unfasten the belt, collar, buttons;

3) spray your face and chest with cold water;

4) rub the body with dry hands - hands, feet, face;

5) let the patient inhale vapors of ammonia;

6) intramuscularly or subcutaneously inject 1 ml of a 10% solution of caffeine, intramuscularly - 1-2 ml of a 25% solution of cordiamine.

Bronchial asthma (attack)

Clinical manifestations- see Nursing in Therapy.

First aid

1) seat the patient, help to take a comfortable position, unfasten the collar, belt, provide emotional peace, access to fresh air;

2) distraction therapy in the form of a hot foot bath (water temperature at the level of individual tolerance);

3) inject 10 ml of a 2.4% solution of aminophylline and 1–2 ml of a 1% solution of diphenhydramine (2 ml of a 2.5% solution of promethazine or 1 ml of a 2% solution of chloropyramine) intravenously;

4) carry out inhalation with an aerosol of bronchodilators;

5) in the case of a hormone-dependent form of bronchial asthma and information from the patient about a violation of the course of hormone therapy, administer prednisolone at a dose and method of administration corresponding to the main course of treatment.

asthmatic status

Clinical manifestations- see Nursing in Therapy.

First aid

1) calm the patient, help to take a comfortable position, provide access to fresh air;

2) oxygen therapy with a mixture of oxygen and atmospheric air;

3) when breathing stops - IVL;

4) administer rheopolyglucin intravenously in a volume of 1000 ml;

5) inject 10–15 ml of a 2.4% solution of aminophylline intravenously during the first 5–7 minutes, then 3–5 ml of a 2.4% solution of aminophylline intravenously by drop in infusion solution or 10 ml each 2.4 % solution of aminophylline every hour into the dropper tube;

6) administer 90 mg of prednisolone or 250 mg of hydrocortisone intravenously by bolus;

7) inject heparin up to 10,000 IU intravenously.

Notes

1. Taking sedatives, antihistamines, diuretics, calcium and sodium preparations (including saline) is contraindicated!

2. Repeated consecutive use of bronchodilators is dangerous due to the possibility of death.

Pulmonary bleeding

Clinical manifestations

Discharge of bright scarlet frothy blood from the mouth when coughing or with little or no cough.

First aid

1) calm the patient, help him take a semi-sitting position (to facilitate expectoration), forbid getting up, talking, calling a doctor;

2) put an ice pack or cold compress on the chest;

3) give the patient a cold liquid to drink: a solution of table salt (1 tablespoon of salt per glass of water), nettle decoction;

4) carry out hemostatic therapy: 1-2 ml of 12.5% ​​solution of dicynone intramuscularly or intravenously, 10 ml of 1% solution of calcium chloride intravenously, 100 ml of 5% solution of aminocaproic acid intravenously, 1-2 ml 1 % solution of vikasol intramuscularly.

If it is difficult to determine the type of coma (hypo- or hyperglycemic), first aid begins with the introduction of a concentrated glucose solution. If the coma is associated with hypoglycemia, then the victim begins to recover, the skin turns pink. If there is no response, then the coma is most likely hyperglycemic. At the same time, clinical data should be taken into account.

Hypoglycemic coma

Clinical manifestations

2. The dynamics of the development of a coma:

1) feeling of hunger without thirst;

2) anxious anxiety;

3) headache;

4) increased sweating;

5) excitement;

6) stunning;

7) loss of consciousness;

8) convulsions.

3. Absence of symptoms of hyperglycemia (dry skin and mucous membranes, decreased skin turgor, softness of the eyeballs, smell of acetone from the mouth).

4. A quick positive effect from intravenous administration of a 40% glucose solution.

First aid

1) inject 40-60 ml of 40% glucose solution intravenously;

2) if there is no effect, re-inject 40 ml of a 40% glucose solution intravenously, as well as 10 ml of a 10% solution of calcium chloride intravenously, 0.5–1 ml of a 0.1% solution of epinephrine hydrochloride subcutaneously (in the absence of contraindications );

3) when feeling better, give sweet drinks with bread (to prevent relapse);

4) patients are subject to hospitalization:

a) at the first appeared hypoglycemic condition;

b) when hypoglycemia occurs in a public place;

c) with the ineffectiveness of emergency medical measures.

Depending on the condition, hospitalization is carried out on a stretcher or on foot.

Hyperglycemic (diabetic) coma

Clinical manifestations

1. History of diabetes mellitus.

2. Development of a coma:

1) lethargy, extreme fatigue;

2) loss of appetite;

3) indomitable vomiting;

4) dry skin;

6) frequent copious urination;

7) decrease in blood pressure, tachycardia, pain in the heart;

8) adynamia, drowsiness;

9) stupor, coma.

3. The skin is dry, cold, the lips are dry, chapped.

4. Tongue crimson with a dirty gray coating.

5. The smell of acetone in the exhaled air.

6. Sharply reduced tone of the eyeballs (soft to the touch).

First aid

Sequencing:

1) carry out rehydration with a 0.9% sodium chloride solution intravenously at a rate of 200 ml infusion over 15 minutes. under the control of the level of blood pressure and spontaneous breathing (cerebral edema is possible with too rapid rehydration);

2) emergency hospitalization in the intensive care unit of a multidisciplinary hospital, bypassing the emergency department. Hospitalization is carried out on a stretcher, lying down.

Acute abdomen

Clinical manifestations

1. Abdominal pain, nausea, vomiting, dry mouth.

2. Soreness on palpation of the anterior abdominal wall.

3. Symptoms of peritoneal irritation.

4. Tongue dry, furred.

5. Subfebrile condition, hyperthermia.

First aid

Urgently deliver the patient to the surgical hospital on a stretcher, in a comfortable position for him. Pain relief, water and food intake are prohibited!

An acute abdomen and similar conditions can occur with a variety of pathologies: diseases of the digestive system, gynecological, infectious pathologies. The main principle of first aid in these cases: cold, hunger and rest.

Gastrointestinal bleeding

Clinical manifestations

1. Paleness of the skin, mucous membranes.

2. Vomiting blood or "coffee grounds".

3. Black tarry stools or scarlet blood (for bleeding from the rectum or anus).

4. The abdomen is soft. There may be pain on palpation in the epigastric region. There are no symptoms of peritoneal irritation, the tongue is wet.

5. Tachycardia, hypotension.

6. In history - peptic ulcer, oncological disease of the gastrointestinal tract, cirrhosis of the liver.

First aid

1) give the patient to eat ice in small pieces;

2) with deterioration of hemodynamics, tachycardia and a decrease in blood pressure - polyglucin (rheopolyglucin) intravenously until stabilization of systolic blood pressure at the level of 100–110 mm Hg. Art.;

3) introduce 60-120 mg of prednisolone (125-250 mg of hydrocortisone) - add to the infusion solution;

4) inject up to 5 ml of a 0.5% dopamine solution intravenously in the infusion solution with a critical drop in blood pressure that cannot be corrected by infusion therapy;

5) cardiac glycosides according to indications;

6) emergency delivery to the surgical hospital lying on a stretcher with the head end lowered.

Renal colic

Clinical manifestations

1. Paroxysmal pain in the lower back, unilateral or bilateral, radiating to the groin, scrotum, labia, anterior or inner thigh.

2. Nausea, vomiting, bloating with retention of stool and gases.

3. Dysuric disorders.

4. Motor anxiety, the patient is looking for a position in which the pain will ease or stop.

5. The abdomen is soft, slightly painful along the ureters or painless.

6. Tapping on the lower back in the kidney area is painful, the symptoms of peritoneal irritation are negative, the tongue is wet.

7. Kidney stone disease in history.

First aid

1) inject 2–5 ml of a 50% solution of analgin intramuscularly or 1 ml of a 0.1% solution of atropine sulfate subcutaneously, or 1 ml of a 0.2% solution of platifillin hydrotartrate subcutaneously;

2) put a hot heating pad on the lumbar region or (in the absence of contraindications) place the patient in a hot bath. Do not leave him alone, control general well-being, pulse, respiratory rate, blood pressure, skin color;

3) hospitalization: with a first attack, with hyperthermia, failure to stop an attack at home, with a repeated attack during the day.

Renal colic is a complication of urolithiasis caused by metabolic disorders. The cause of the pain attack is the displacement of the stone and its entry into the ureters.

Anaphylactic shock

Clinical manifestations

1. Connection of the state with the administration of a drug, vaccine, intake of a specific food, etc.

2. Feeling of fear of death.

3. Feeling of lack of air, retrosternal pain, dizziness, tinnitus.

4. Nausea, vomiting.

5. Seizures.

6. Sharp pallor, cold sticky sweat, urticaria, swelling of soft tissues.

7. Tachycardia, thready pulse, arrhythmia.

8. Severe hypotension, diastolic blood pressure is not determined.

9. Coma.

First aid

Sequencing:

1) in case of shock caused by intravenous allergen medication, leave the needle in the vein and use it for emergency anti-shock therapy;

2) immediately stop the administration of the medicinal substance that caused the development of anaphylactic shock;

3) give the patient a functionally advantageous position: elevate the limbs at an angle of 15°. Turn your head to one side, in case of loss of consciousness, push the lower jaw forward, remove dentures;

4) carry out oxygen therapy with 100% oxygen;

5) inject intravenously 1 ml of a 0.1% solution of adrenaline hydrochloride diluted in 10 ml of a 0.9% solution of sodium chloride; the same dose of epinephrine hydrochloride (but without dilution) can be injected under the root of the tongue;

6) polyglucin or other infusion solution should be started to be administered by jet after stabilization of systolic blood pressure at 100 mm Hg. Art. - continue infusion therapy drip;

7) introduce 90–120 mg of prednisolone (125–250 mg of hydrocortisone) into the infusion system;

8) inject 10 ml of 10% calcium chloride solution into the infusion system;

9) in the absence of the effect of the therapy, repeat the administration of adrenaline hydrochloride or inject 1–2 ml of a 1% solution of mezaton intravenously;

10) in case of bronchospasm, inject 10 ml of a 2.4% solution of aminophylline intravenously;

11) with laryngospasm and asphyxia - conicotomy;

12) if the allergen was injected intramuscularly or subcutaneously or an anaphylactic reaction occurred in response to an insect bite, it is necessary to chop off the injection or bite site with 1 ml of a 0.1% solution of adrenaline hydrochloride diluted in 10 ml of a 0.9% solution of sodium chloride ;

13) if the allergen entered the body by mouth, it is necessary to wash the stomach (if the patient's condition allows);

14) in case of convulsive syndrome, inject 4–6 ml of a 0.5% solution of diazepam;

15) in case of clinical death, perform cardiopulmonary resuscitation.

In each treatment room, there must be a first aid kit for first aid in case of anaphylactic shock. Most often, anaphylactic shock develops during or after the introduction of biological products, vitamins.

Quincke's edema

Clinical manifestations

1. Communication with the allergen.

2. Itchy rash on various parts of the body.

3. Edema of the rear of the hands, feet, tongue, nasal passages, oropharynx.

4. Puffiness and cyanosis of the face and neck.

6. Mental excitement, restlessness.

First aid

Sequencing:

1) stop introducing the allergen into the body;

2) inject 2 ml of a 2.5% solution of promethazine, or 2 ml of a 2% solution of chloropyramine, or 2 ml of a 1% solution of diphenhydramine intramuscularly or intravenously;

3) administer 60–90 mg of prednisolone intravenously;

4) inject 0.3–0.5 ml of a 0.1% solution of adrenaline hydrochloride subcutaneously or, diluting the drug in 10 ml of a 0.9% solution of sodium chloride, intravenously;

5) inhalation with bronchodilators (fenoterol);

6) be ready for conicotomy;

7) to hospitalize the patient.

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• fainting
• Collapse
• Hypertensive crisis
• Anaphylactic shock
• An attack of angina pectoris
• Acute myocardial infarction
• clinical death

Algorithms for providing first aid in emergency conditions

Fainting

Fainting is an attack of short-term loss of consciousness due to transient cerebral ischemia associated with a weakening of cardiac activity and an acute dysregulation of vascular tone. Depending on the severity of the factors contributing to the violation of cerebral circulation.

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

Stages of development of fainting.

1. Harbingers (pre-syncope). Clinical manifestations: discomfort, dizziness, tinnitus, shortness of breath, cold sweat, numbness of the fingertips. Lasts from 5 seconds to 2 minutes.

2. Violation of consciousness (actual fainting). Clinic: loss of consciousness lasting from 5 seconds to 1 minute, accompanied by pallor, decreased muscle tone, dilated pupils, their weak reaction to light. Breathing shallow, bradypnea. The pulse is labile, more often bradycardia is up to 40-50 per minute, systolic blood pressure drops to 50-60 mm. rt. Art. With deep fainting, convulsions are possible.

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

Algorithm of therapeutic measures

2. Unbutton the collar.

3. Provide access to fresh air.

4. Wipe your face with a damp cloth or spray with cold water.

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

In case of ineffectiveness of the above measures:

6. Caffeine 2.0 IV or IM.

7. Cordiamin 2.0 i/m.

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

9. When recovering from fainting, continue dental manipulations with measures to prevent relapse: treatment should be carried out with the patient in a horizontal position with adequate premedication and sufficient anesthesia.

Collapse

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

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

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

2. Provide fresh air supply.

3. Prednisolone 60-90 mg IV.

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

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

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

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

Hypertensive crisis

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

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

Algorithm of therapeutic measures 1. Intravenously in one syringe: Dibazol 1% - 4.0 ml with papaverine 1% - 2.0 ml (slowly).

2. In severe cases: clonidine 75 mcg under the tongue.

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

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

5. Sedatives - Elenium inside 1-2 tablets.

6. Hospitalization.

It is necessary to constantly monitor blood pressure!

first aid fainting

Anaphylactic shock

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

The patient has an acute state of discomfort with vague painful sensations. There is a fear of death or a state of inner unrest. There is nausea, sometimes vomiting, coughing. Patients complain of severe weakness, tingling and itching of the skin of the face, hands, head; a feeling of a rush of blood to the head, face, a feeling of heaviness behind the sternum or chest compression; the appearance of pain in the heart, difficulty breathing or the inability to exhale, dizziness or headache. Disorder of consciousness occurs in the terminal phase of shock and is accompanied by impaired verbal contact with the patient. Complaints occur immediately after taking the drug.

The clinical picture of LASH: hyperemia of the skin or pallor and cyanosis, swelling of the eyelids of the face, profuse sweating. Noisy breathing, tachypnea. Most patients develop restlessness. Mydriasis is noted, the reaction of pupils to light is weakened. The pulse is frequent, sharply weakened in the peripheral arteries. Blood pressure decreases rapidly, in severe cases, diastolic pressure is not detected. There is shortness of breath, shortness of breath. Subsequently, the clinical picture of pulmonary edema develops.

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

Algorithm of therapeutic measures Urgently provide access to the vein.

1. Stop the administration of the drug that caused anaphylactic shock. Call for an ambulance.

2. Lay the patient down, raise the lower limbs. If the patient is unconscious, turn his head to the side, push the lower jaw. Humidified oxygen inhalation. Ventilation of the lungs.

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

4. Prednisolone 90-120 mg IV.

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

6. Cardiac glycosides according to indications.

7. With obstruction of the respiratory tract - oxygen therapy, 2.4% solution of aminophylline 10 ml intravenously for physical. solution.

8. If necessary - endotracheal intubation.

9. Hospitalization of the patient. Allergy identification.

Toxic reactions to anesthetics

clinical picture. Restlessness, tachycardia, dizziness and weakness. Cyanosis, muscle tremor, chills, convulsions. Nausea, sometimes vomiting. Respiratory distress, decreased blood pressure, collapse.

Algorithm of therapeutic measures

1. Give the patient a horizontal position.

2. Fresh air. Let the vapors of ammonia be inhaled.

3. Caffeine 2 ml s.c.

4. Cordiamin 2 ml s.c.

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

6. Adrenaline 0.1% - 1.0 ml per physical. solution in / in.

7. Prednisolone 60-90 mg IV.

8. Tavegil, suprastin, diphenhydramine.

9. Cardiac glycosides (according to indications).

An attack of angina pectoris

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

An attack of angina pectoris provokes an increase in blood pressure, psycho-emotional stress, which always occurs before and during treatment with a dentist.

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

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

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

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

5. In the absence of effect - call an ambulance and hospitalization.

Acute myocardial infarction

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

Clinic. The most characteristic clinical symptom is pain, which is more often localized in the region of the heart behind the sternum, less often captures the entire front surface of the chest. Irradiates to the left arm, shoulder, shoulder blade, interscapular space. The pain usually has a wave-like character: it intensifies, then weakens, it lasts from several hours to several days. Objectively noted pale skin, cyanosis of the lips, excessive sweating, decreased blood pressure. In most patients, the heart rhythm is disturbed (tachycardia, extrasystole, atrial fibrillation).

Algorithm of therapeutic measures

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

2. Calling a cardiological ambulance team.

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

4. Compulsory relief of pain syndrome: baralgin 5 ml or analgin 50% - 2 ml intravenously or intramuscularly.

5. Inhalation of oxygen through a mask.

6. Papaverine 2% - 2.0 ml / m.

7. Eufillin 2.4% - 10 ml per physical. r-re in / in.

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

clinical death

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

Algorithm of therapeutic measures REANIMATION:

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

2. Clear the airways.

3. Insert an air duct, carry out artificial ventilation of the lungs and external heart massage.

during resuscitation by one person in the ratio: 2 breaths per 15 compressions of the sternum; during resuscitation together in the ratio: 1 breath for 5 compressions of the sternum. Take into account that the frequency of artificial respiration is 12-18 per minute, and the frequency of artificial circulation is 80-100 per minute. Artificial ventilation of the lungs and external heart massage are carried out before the arrival of "resuscitation".

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

1. Adrenaline 0.1% - 0.5 ml diluted 5 ml. physical solution or glucose intracardiac (preferably - intertracheally).

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

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

4. Sodium bicarbonate 4% - 200 ml IV.

5. Ascorbic acid 5% - 3-5 ml IV.

6. Cold to the head.

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

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

In practice, all of these activities are carried out simultaneously.

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presentation, added 11/14/2016


The concept and clinical picture of bleeding; their classification according to origin, type of bleeding vessel and place of outpouring of blood. Rules for imposing an arterial tourniquet. Causes of traumatic shock; first aid principles.

presentation, added 10/21/2014


Study of the erectile and torpid phases of traumatic shock. Diagnosis of the degree of shock. Determining the value of the shock index. Correction of respiratory failure. Algorithm for emergency medical care in emergency conditions at the prehospital stage.

report, added 12/23/2013


Hypertensive crisis as one of the most frequent and dangerous complications of hypertension, its clinical manifestations and characteristic symptoms, forms and rules of first aid. Differential diagnosis of hypertensive crises and its complications.

"Providing first aid in various conditions"

Emergency conditions that threaten the life and health of the patient require urgent measures at all stages of medical care. These conditions arise as a result of the development of shock, acute blood loss, respiratory disorders, circulatory disorders, coma, which are caused by acute diseases of the internal organs, traumatic injuries, poisoning and accidents.

The most important place in providing assistance to suddenly ill and injured as a result of natural and man-made emergencies in peacetime is given to adequate pre-hospital measures. According to the data of domestic and foreign experts, a significant number of patients and victims of emergencies could be saved if timely and effective assistance was provided at the pre-hospital stage.

Currently, the importance of first aid in the treatment of emergency conditions has increased tremendously. The ability of nursing staff to assess the severity of the patient's condition, identify priority problems is necessary to provide effective first aid, which can have a greater impact on the further course and prognosis of the disease. From a health worker, not only knowledge is required, but also the ability to quickly provide assistance, since confusion and inability to collect oneself can even aggravate the situation.

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

Modern principles of emergency medical care

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

The main steps in this scheme are:

1. Immediate initiation of urgent life support measures in the event of an emergency.

2. Organization of the arrival of qualified specialists at the scene of the incident as soon as possible, the implementation of certain measures of emergency medical care during the transportation of the patient to the hospital.

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

Measures to be taken in the event of an emergency

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

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

The most important factor in emergency care is the time factor. The best results in the treatment of victims and patients are achieved when the period from the onset of an emergency to the time of provision of qualified assistance does not exceed 1 hour.

A preliminary assessment of the severity of the patient's condition will help to avoid panic and fuss during subsequent actions, will provide an opportunity to make more balanced and rational decisions in extreme situations, as well as measures for emergency evacuation of the victim from the danger zone.

After that, it is necessary to begin to identify the signs of the most life-threatening conditions that can lead to the death of the victim in the next few minutes:

clinical death;

coma;

Arterial bleeding

Neck injuries

chest injury.

The person providing assistance to victims in an emergency should strictly adhere to the algorithm shown in Scheme 1.

Scheme 1. The procedure for providing assistance in an emergency

Providing first aid in case of an emergency

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

Inspection of the scene. Ensure safety when providing assistance.

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

Call a doctor or ambulance.

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

Before helping the injured, find out:

· Is the scene dangerous?

· What happened;

The number of patients and victims;

Whether others are able to help.

Anything that can endanger your safety and the safety of others is of particular importance: exposed electrical wires, falling debris, heavy traffic, fire, smoke, harmful fumes. If you are in any danger, do not approach the victim. Call the appropriate rescue service or police immediately for professional assistance.

Always look for other casualties and, if necessary, ask others to assist you in helping you.

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

find out from the victim what happened;

Explain that you are a healthcare worker;

offer assistance, obtain the consent of the victim to provide assistance;

· Explain what action you are going to take.

You must obtain permission from the casualty before performing emergency first aid. A conscious victim has the right to refuse your service. If he is unconscious, we can assume that you have received his consent to carry out emergency measures.

Bleeding

Methods for stopping bleeding:

1. Finger pressure.

2. Tight bandage.

Maximum limb flexion.

The imposition of a tourniquet.

Applying a clamp to a damaged vessel in a wound.

Tamponade of the wound.

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

Any movement of the limb stimulates blood flow in it. In addition, when blood vessels are damaged, blood coagulation processes are disrupted. Any movement causes additional damage to blood vessels. Splinting limbs can reduce bleeding. Air tyres, or any type of tyre, are ideal in this case.

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

In case of bleeding in the area of ​​the skin of the head, the temporal artery should be pressed against the surface of the temporal bone. Brachial artery - to the surface of the humerus in case of injury to the forearm. Femoral artery - to the pelvic or femur in case of injury to the lower limb.

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

The principles of applying a tourniquet:

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

§ it is necessary to tighten the tourniquet only until the peripheral pulse disappears and the bleeding stops;

§ each subsequent tour of the harness must partially capture the previous tour;

§ the tourniquet is applied for no more than 1 hour in the warm period of time, and no more than 0.5 hours in the cold;

§ a note is inserted under the applied tourniquet indicating the time the tourniquet was applied;

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

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

fractures

§ Checking the patency of the respiratory tract, breathing and circulation;

§ the imposition of transport immobilization by personnel means;

§ aseptic dressing;

§ anti-shock measures;

§ transportation to health facilities.

With a fracture of the lower jaw:

Emergency first aid:

§ check airway patency, respiration, blood circulation;

§ temporarily stop arterial bleeding by pressing the bleeding vessel;

§ fix the lower jaw with a sling bandage;

§ If the tongue is retracted, making it difficult to breathe, fix the tongue.

Rib fractures.

Emergency first aid:

§ apply a circular pressure bandage on the chest as you exhale;

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

Wounds

Emergency first aid:

§ check ABC (airway patency, respiration, circulation);

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

First aid for open wounds:

§ stop the main bleeding;

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

§ apply an aseptic bandage;

§ for extensive wounds, fix the limb

lacerations are divided into:

superficial (including only the skin);

deep (capture underlying tissues and structures).

stab wounds usually not accompanied by massive external bleeding, but be careful about the possibility of internal bleeding or tissue damage.

Emergency first aid:

§ do not remove deeply stuck objects;

§ stop bleeding;

§ Stabilize the foreign body with bulk dressing and immobilize with splints as needed.

§ apply an aseptic dressing.

Thermal damage

burns

Emergency first aid:

§ termination of the thermal factor;

§ cooling the burnt surface with water for 10 minutes;

§ the imposition of an aseptic dressing on the burn surface;

§ warm drink;

§ evacuation to the nearest medical facility in the prone position.

Frostbite

Emergency first aid:

§ stop the cooling effect;

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

§ provide thermal insulation of the cooled limb segments;

§ to evacuate the victim to the nearest hospital in the prone position.

Solar and heat stroke

Emergency first aid:

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

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

§ lay the victim on his back;

§ if the victim has low blood pressure, raise the lower limbs.

Acute vascular insufficiency

Fainting

Emergency first aid:

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

§ unfasten tight clothing;

§ provide access to fresh air;

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

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

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

If an organic cause of syncope is suspected, hospitalization is necessary.

convulsions

Emergency first aid:

§ protect the patient from bruises;

§ free him from restrictive clothing;

medical emergency

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

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

Lightning strike

Emergency first aid:

§ restoration and maintenance of airway patency and artificial lung ventilation;

§ indirect heart massage;

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

Pelectric shock

First aid for electrical injury:

§ free the victim from contact with the electrode;

§ preparation of the victim for resuscitation;

§ carrying out IVL in parallel with closed heart massage.

Stings of bees, wasps, bumblebees

Emergency first aid:

remove the sting from the wound with tweezers;

treat the wound with alcohol;

Apply a cold compress.

Hospitalization is necessary only with a general or pronounced local reaction.

Bites of poisonous snakes

Emergency first aid:

§ complete rest in a horizontal position;

§ locally - cold;

§ immobilization of the injured limb with improvised means;

§ plentiful drink;

§ transportation in the prone position;

Suction of blood from the wound by mouth is prohibited!

Bites from dogs, cats, wild animals

Emergency first aid:

§ when bitten by a domestic dog and the presence of a small wound, the toilet of the wound is carried out;

§ a bandage is applied;

§ the victim is sent to a trauma center;

§ large bleeding wounds are packed with napkins.

Indications for hospitalization are bite wounds received from unknown and not vaccinated against rabies animals.

poisoning

Emergency first aid for acute oral poisoning:

perform gastric lavage in a natural way (induce vomiting);

Provide access to oxygen

ensure prompt transportation to a specialized toxicological department.

Emergency first aid for inhalation poisoning:

stop the flow of poison into the body;

provide the victim with oxygen;

ensure prompt transportation to a specialized toxicological department or intensive care unit.

Emergency first aid for resorptive poisoning:

stop the flow of poison into the body;

clean and wash the skin from the toxic substance (use a soapy solution for washing)

If necessary, provide transportation to a health facility.

Alcohol poisoning and its surrogates

Emergency first aid:

plentiful drink;

Acetic acid

Emergency first aid:

· while maintaining consciousness, give inside 2-3 glasses of milk, 2 raw eggs;

Ensure that the patient is transported to the nearest medical facility in the supine position.

Carbon monoxide

Emergency first aid: drag the victim to a safe place; unfasten the belt, collar, provide access to fresh air; warm the victim to ensure the hospitalization of the victim in a medical facility.

mushroom poisoning

Emergency first aid:

tubeless gastric lavage;

plentiful drink;

inside adsorbents - activated carbon, and laxative;

Ensure that the patient is transported to the nearest medical facility in the supine position.

Personal safety and measures for the protection of medical personnel in the provision of emergency care

Prevention of occupational infection includes universal precautionary measures, which provide for the implementation of a number of measures aimed at preventing contact of medical workers with biological fluids, organs and tissues of patients, regardless of the epidemiological history, the presence or absence of specific diagnostic results.

Medical workers should treat blood and other biological fluids of the human body as potentially dangerous in terms of possible infection, therefore, when working with them, the following rules must be observed:

In case of any contact with blood, other biological fluids, organs and tissues, as well as with mucous membranes or damaged skin of patients, the medical worker must be dressed in special clothing.

2. Other means of barrier protection - a mask and goggles - should be worn in cases where the possibility of splashing blood and other body fluids cannot be ruled out.

When performing various procedures, it is necessary to take measures to prevent injury from cutting and stabbing objects. Cutting and piercing tools must be handled carefully, without unnecessary fuss, and every movement should be thoughtfully performed.

In the event of an "emergency" it is necessary to use the laying for emergency prevention of parenteral viral hepatitis and HIV infection.

Definition. Emergency conditions are pathological changes in the body that lead to a sharp deterioration in health, threaten the life of the patient and require emergency therapeutic measures. There are the following emergency conditions:

Immediate 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 respiratory function

relief of collapse, shock of any etiology

relief of convulsive syndrome

prevention and treatment of cerebral edema

CARDIOLUMMARY REANIMATION.

Definition. Cardiopulmonary resuscitation (CPR) is a set of measures aimed at restoring lost or severely impaired vital body functions in patients in a state of clinical death.

The main 3 receptions of CPR according to P. Safar, "rule ABC":

A ire way open - ensure airway patency;

B reath for victim - start artificial respiration;

C irculation his blood - restore blood circulation.

A- carried out triple trick according to Safar - tilting the head, the maximum forward displacement of the lower jaw and opening the patient's mouth.

Give the patient an appropriate position: lay on a hard surface, putting a roller of clothes on his back under the shoulder blades. Tilt your head as far back as possible

Open your mouth and examine the oral cavity. With convulsive compression of the masticatory muscles, use a spatula to open it. Clear the oral cavity of mucus and vomit with a handkerchief wound around the index finger. If the tongue is sunk, turn it out with the same finger

Rice. Preparation 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-capturing the lower jaw, 3-using a spacer, 4-triple reception. b- cleaning of the oral cavity: 1 - with the help of a finger, 2 - with the help of suction. (fig. by Moroz F.K.)

B - artificial lung ventilation (ALV). IVL is the blowing of air or an oxygen-enriched mixture into the lungs of a patient without / using special devices. Each breath should take 1-2 seconds, and the respiratory rate should be 12-16 per minute. IVL at the stage of pre-hospital care is carried out "mouth to mouth" or "mouth to nose" exhaled air. At the same time, the effectiveness of inhalation is judged by the rise of the chest and passive exhalation of air. Either an airway, face mask and Ambu bag, or tracheal intubation and Ambu bag are usually used by the ambulance team.

C - indirect heart massage.

The patient lies on his back on a hard surface. The caregiver stands on the side of the victim and puts the hand of one hand on the lower middle third of the sternum, and the second hand on top, across the first to increase pressure.

the doctor should stand high enough (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 effort of his hands, but also with the weight of his body.

The rescuer's shoulders should be directly above the palms, the arms should not be bent at the elbows. With rhythmic pushes of the proximal part of the hand, they press on 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 determine the artificial pulse wave on the carotid or femoral artery.

The number of chest compressions should be 100 in 1 minute

The ratio of chest compressions to artificial respiration in adults is 30: 2 whether one or two people are doing CPR.

In children, 15:2 if CPR is performed by 2 people, 30:2 if it is performed by 1 person.

simultaneously with the onset of mechanical ventilation and massage intravenous bolus: every 3-5 minutes 1 mg of adrenaline or 2-3 ml endotracheally; atropine - 3 mg intravenously bolus once.

Rice. The position of the patient and assisting with chest compressions.

ECG- asystole ( isoline on the ECG)

intravenously 1 ml of 0.1% solution of epinephrine (adrenaline), repeated intravenously after 3-4 minutes;

intravenous atropine 0.1% solution - 1 ml (1 mg) + 10 ml of 0.9% solution of sodium chloride after 3-5 minutes (until the effect or a total dose of 0.04 mg / kg is obtained);

Sodium bicarbonate 4% - 100 ml is administered only after 20-25 minutes of CPR.

if asystole persists, immediate percutaneous, transesophageal, or endocardial temporary pacing.

ECG- ventricular fibrillation (ECG - teeth of different amplitudes randomly located)

electrical defibrillation (EIT). Shocks of 200, 200 and 360 J (4500 and 7000 V) are recommended. All subsequent discharges - 360 J.

In ventricular fibrillation, after the 3rd shock, cordarone in the initial dose of 300 mg + 20 ml of 0.9% sodium chloride solution or 5% glucose solution, again - 150 mg each (up to a maximum of 2 g). In the absence of cordarone, enter lidocaine- 1-1.5 mg/kg every 3-5 minutes for a total dose of 3 mg/kg.

Magnesia sulfate - 1-2 g IV for 1-2 minutes, repeat after 5-10 minutes.

EMERGENCY AID FOR ANAPHILACTIC SHOCK.

Definition. Anaphylactic shock is a systemic allergic reaction of an immediate type to the repeated administration of an allergen as a result of a rapid massive immunoglobulin-E-mediated release of mediators from tissue basophils (mast cells) and basophilic granulocytes of peripheral blood (R.I. Shvets, E.A. Fogel, 2010 .).

Provoking factors:

taking medications: penicillin, sulfonamides, streptomycin, tetracycline, nitrofuran derivatives, amidopyrine, aminophylline, eufillin, diafillin, barbiturates, anthelmintic drugs, thiamine hydrochloride, glucocorticosteroids, novocaine, sodium thiopental, diazepam, radiopaque and iodine-containing substances.

Administration of blood products.

Food products: chicken eggs, coffee, cocoa, chocolate, strawberries, strawberries, crayfish, fish, milk, alcoholic beverages.

Administration of vaccines and sera.

Insect stings (wasps, bees, mosquitoes)

Pollen allergens.

Chemicals (cosmetics, detergents).

Local manifestations: edema, hyperemia, hypersalivation, necrosis

Systemic manifestations: shock, bronchospasm, DIC, 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 poisonous gland of the insect 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 above the legs), turn the head to the side, push the lower jaw forward, if there are removable dentures, remove them.

If necessary, perform CPR, tracheal intubation; with laryngeal edema - tracheostomy.

Indications for mechanical ventilation in anaphylactic shock:

Swelling of the larynx and trachea with impaired patency  - respiratory tract;

Intractable arterial hypotension;

Violation of consciousness;

Persistent bronchospasm;

Pulmonary edema;

Development - coagulopathy bleeding.

Immediate tracheal intubation and mechanical ventilation is performed with loss of consciousness, a decrease in systolic blood pressure below 70 mm Hg. Art., in the event 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 largest possible diameter.

Medical therapy:

Provide intravenous access into two veins and start transfusion of 0.9% - 1.000 ml of sodium chloride solution, stabisol - 500 ml, polyglucin - 400 ml

Epinephrine (adrenaline) 0.1% - 0.1 -0.5 ml intramuscularly, if necessary, repeat after 5-20 minutes.

In moderate anaphylactic shock, a fractional (bolus) injection of 1-2 ml of a mixture (1 ml of -0.1% adrenaline + 10 ml of 0.9% sodium chloride solution) is shown every 5-10 minutes until hemodynamic stabilization.

Intratracheal epinephrine is administered in the presence of an endotracheal tube in the trachea - as an alternative to intravenous or intracardiac routes of administration (2-3 ml at a time in a dilution of 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).

with generalized urticaria or with a combination of urticaria with Quincke's edema - diprospan (betamethasone) - 1-2 ml intramuscularly.

with Quincke's edema, a combination of prednisolone and new generation antihistamines is indicated: semprex, telfast, clarifer, allertec.

membrane stabilizers intravenously: ascorbic acid 500 mg/day (8–10 10 ml of 5% solution or 4–5 ml of 10% solution), troxevasin 0.5 g/day (5 ml of 10% solution), sodium etamsylate 750 mg/day (1 ml = 125 mg), the initial dose is 500 mg, then every 8 hours, 250 mg.

intravenously eufillin 2.4% 10–20  ml, no-shpa 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 systolic pressure reaches 90 mm Hg) and is prescribed only after replenishment of the circulating blood volume.

with persistent bronchospasm 2 ml (2.5 mg) salbutamol or berodual (fenoterol 50 mg, iproaropium bromide 20 mg) preferably through a nebulizer

with bradycardia, atropine 0.5 ml -0.1% of the 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 action 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 intensive care unit / allergology with generalized urticaria, Quincke's edema.

EMERGENCY CARE FOR ACUTE CARDIOVASCULAR FAILURE: CARDIOGENIC SHOCK, FANE COLLAPSE

Definition. Acute cardiovascular failure is a pathological condition caused by the inadequacy of cardiac output to the metabolic needs of the body. It can 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 of occurrence: arterial hypertension, acquired and congenital heart defects, pulmonary embolism, myocardial infarction, myocarditis, cardiosclerosis, myocardiopathies. Conventionally, cardiovascular insufficiency 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, 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 form and severity. There are 3 main forms: reflex (pain), arrhythmogenic, true.

reflex cardiogenic shock complication of myocardial infarction that occurs at the height of the pain attack. It often occurs with lower-posterior localization of a heart attack in middle-aged men. Hemodynamics normalizes after the relief of the pain attack.

Arrhythmogenic cardiogenic shock a consequence of cardiac arrhythmia, more often against the background of ventricular tachycardia> 150 per 1 minute, atrial fibrillation, ventricular fibrillation.

True cardiogenic shock a consequence of a violation of myocardial contractility. The most severe form of shock against the background of extensive necrosis of the left ventricle.

Weakness, lethargy or short-term psychomotor agitation

The face is pale with a grayish-ash tint, the skin is marbled

Cold clammy sweat

Acrocyanosis, cold extremities, collapsed veins

The main symptom is a sharp drop in SBP< 70 мм. рт. ст.

Tachycardia, shortness of breath, signs of pulmonary edema

oliguria

0.25 mg acetylsalicylic acid to chew in the mouth

Lay down the patient with raised lower limbs;

oxygen therapy with 100% oxygen.

With an anginal attack: 1 ml of a 1% solution of morphine or 1-2 ml of a 0.005% solution of fentanyl.

Heparin 10,000 -15,000 IU + 20 ml of 0.9% sodium chloride intravenously drip.

400 ml of 0.9% sodium chloride solution or 5% glucose solution intravenously over 10 minutes;

intravenous jet solutions of polyglucin, refortran, stabisol, reopoliglyukin until blood pressure stabilizes (SBP 110 mm Hg)

With heart rate> 150 per minute. – absolute indication for EIT, heart rate<50 в мин абсолютное показание к ЭКС.

No stabilization of blood pressure: dopmin 200 mg intravenously + 400 ml of 5% glucose solution, the rate of administration is from 10 drops per minute until the SBP is 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 μg / min to SBP 90 mm Hg. Art.

if the SBP is more than 90 mm Hg: 250 mg of dobutamine solution + in 200 ml of 0.9% sodium chloride intravenously by drip.

Hospitalization in 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 due to an acute insufficiency of blood flow to the brain. Causes: negative emotions (stress), pain, a sudden change in body position (orthostatic) with a disorder of the nervous regulation of vascular tone.

Tinnitus, general weakness, dizziness, pallor of the face

Loss of consciousness, the patient falls

Pale skin, cold sweat

Pulse is thready, blood pressure drops, extremities are cold

The duration of fainting from a few minutes to 10-30 minutes

Lay the patient down with head down and legs up, free from tight clothing

Give a sniff of 10% aqueous ammonia (ammonia)

Midodrine (gutron) orally 5 mg (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

With bradycardia and cardiac arrest atropine sulfate 0.5 - 1 mg intravenously by bolus

When breathing and circulation stops - CPR

Collapse emergency.

Definition. Collapse is an acute vascular insufficiency that occurs as a result of inhibition of the sympathetic nervous system and an increase in the tone of the vagus nerve, which is accompanied by the expansion of arterioles and a violation of the ratio between the capacity of the vascular bed and the bcc. As a result, venous return, cardiac output and cerebral blood flow are reduced.

Reasons: pain or its expectation, a sharp change in body position (orthostatic), an overdose of antiarrhythmic drugs, ganglioblockers, local anesthetics (novocaine). Antiarrhythmic drugs.

General weakness, dizziness, tinnitus, yawning, nausea, vomiting

Paleness of the skin, cold clammy sweat

Decreased blood pressure (systolic blood pressure less than 70 mm Hg), bradycardia

Possible loss of consciousness

Horizontal position with legs elevated

1 ml 25% cordiamine solution, 1-2 ml 10% caffeine solution

0.2 ml 1% mezaton solution or 0.5 - 1 ml 0.1% epinephrine solution

For prolonged collapse: 3–5 mg/kg hydrocortisone or 0.5–1 mg/kg prednisone

With severe bradycardia: 1 ml -0.15 solution of atropine sulfate

200 -400 ml of polyglucin / rheopolyglucin

Article 11 Federal Law No. 323-FZ dated November 21, 2011“On the fundamentals of protecting the health of citizens in the Russian Federation” (hereinafter referred to as Federal Law No. 323) says that in an emergency form it is provided by a medical organization and a medical worker to a citizen immediately and free of charge. Refusal to provide it is not allowed. A similar wording was in the old Fundamentals of Legislation on the Protection of the Health of Citizens in the Russian Federation (approved by the Supreme Court of the Russian Federation on 07/22/1993 N 5487-1, became invalid from 01/01/2012), although the concept "" appeared in it. What is emergency medical care and what is its difference from the emergency form?

An attempt to isolate emergency medical care from emergency or emergency medical care familiar to each of us was previously made by officials of the Ministry of Health and Social Development of Russia (since May 2012 -). Therefore, approximately since 2007, we can talk about the beginning of some separation or differentiation of the concepts of "emergency" and "urgent" care at the legislative level.

However, in the explanatory dictionaries of the Russian language there are no clear differences between these categories. Urgent - one that cannot be postponed; urgent. Urgent - urgent, emergency, urgent. Federal Law No. 323 put an end to this issue by approving three different forms of medical care: emergency, urgent and planned.

emergency

Medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases that threaten the patient's life.

urgent

Medical care provided in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient's life.

Planned

Medical assistance that is provided during preventive measures, in case of diseases and conditions that are not accompanied by a threat to the life of the patient, that do not require emergency and urgent medical care, and the delay in the provision of which for a certain time will not entail a deterioration in the patient's condition, a threat to his life and health.

As you can see, emergency and emergency medical care are opposed to each other. At the moment, absolutely any medical organization is obliged to provide only emergency medical care free of charge and without delay. So are there any significant differences between the two concepts under discussion?

The main difference is that the EMF appears in cases constituting life threatening person, and urgent - without obvious signs of a threat to life. However, the problem lies in the fact that the legislation does not clearly define which cases and conditions are considered a threat, and which are not. Moreover, it is not clear what is considered a clear threat? Diseases, pathological conditions, signs that indicate a threat to life are not described. The mechanism for determining the threat is not indicated. Among other things, the condition may not be a life-threatening condition at a particular moment, but failure to provide assistance will lead to a life-threatening condition in the future.

In view of this, a completely fair question arises: how to distinguish a situation when emergency care is needed, how to draw a line between emergency and emergency care. An excellent example of the difference between emergency and emergency care is indicated in the article by Professor A.A. Mokhova "Features of legislative regulation of the provision of emergency and urgent care in Russia":

But unfortunately, this is also not enough. In this matter, it is unequivocally impossible to do without the participation of our "legislators". The solution of the problem is necessary not only for theory, but also for "practice". One of the reasons, as mentioned earlier, is the obligation of each medical organization to provide free medical care in an emergency form, while emergency care can be provided on a paid basis.

It is important to note that the "image" of emergency medical care is still "collective". One of the reasons is territorial programs of state guarantees of free provision of medical care to citizens (hereinafter referred to as TPSG), which contain (or do not contain) various provisions regarding the procedure and conditions for the provision of EMT, urgency criteria, the procedure for reimbursement of expenses for the provision of EMT, and so on.

For example, TPSG 2018 of the Sverdlovsk Region indicates that the case of emergency medical care must meet the criteria for an emergency: suddenness, acute condition, life-threatening. Some TPGG mention the criteria of urgency, referring to the Order of the Ministry of Health and Social Development of the Russian Federation dated April 24, 2008 No. 194n “On approval of the Medical criteria for determining the severity of harm caused to human health” (hereinafter - Order No. 194n). For example, TPSG 2018 of the Perm Territory indicates that the criterion for the urgency of medical care is the presence of life-threatening conditions defined in:

• Clause 6.1 of Order No. 194n (harm to health, dangerous to human life, which by its nature directly poses a threat to life, as well as harm to health that caused the development of a life-threatening condition, namely: a head wound; contusion of the cervical spinal cord with a violation of its functions, etc.*);
• clause 6.2 of Order No. 194n (harm to health, dangerous to human life, causing a disorder in the vital functions of the human body, which cannot be compensated by the body on its own and usually ends in death, namely: severe III-IV degree shock; acute, profuse or massive blood loss, etc. *).

* The full list is defined in Order No. 194n.

According to officials of the ministry, emergency medical care is provided if the existing pathological changes in the patient are not life-threatening. But from various regulatory legal acts of the Ministry of Health and Social Development of Russia, it follows that there are no significant differences between emergency and emergency medical care.

Some TPSG indicate that the provision of medical care in an emergency form is carried out in accordance with emergency medical care standards, approved by orders of the Ministry of Health of Russia, according to conditions, syndromes, diseases. And, for example, TPSG 2018 of the Sverdlovsk Region means that emergency care is provided on an outpatient, inpatient and day hospital basis in the following cases:

• in the event of an emergency condition in a patient on the territory of a medical organization (when a patient seeks medical care in a planned form, for diagnostic studies, consultations);
• when a patient independently applies or is delivered to a medical organization (as the closest one) by relatives or other persons in the event of an emergency;
• in the event of an emergency condition in a patient at the time of treatment in a medical organization, carrying out planned manipulations, operations, studies.

Among other things, it is important to note that in case of a citizen’s health condition requiring emergency medical care, the citizen’s examination and therapeutic measures are carried out at the place of his appeal immediately by the medical worker to whom he applied.

Unfortunately, Federal Law No. 323 contains only the analyzed concepts themselves without the criteria “separating” these concepts. In view of this, a number of problems arise, the main of which is the difficulty of determining in practice the presence of a threat to life. As a result, there is an urgent need for a clear description of diseases and pathological conditions, signs indicating a threat to the life of the patient, with the exception of the most obvious (for example, penetrating wounds of the chest, abdominal cavity). It is not clear what the mechanism for determining the threat should be.

Order of the Ministry of Health of Russia dated June 20, 2013 No. 388n “On approval of the Procedure for the provision of emergency, including emergency specialized, medical care” makes it possible to deduce some conditions that indicate a threat to life. The order states that the reason for calling an ambulance in emergency form are sudden acute diseases, conditions, exacerbations of chronic diseases that pose a threat to the life of the patient, including:

• disturbances of consciousness;
• respiratory disorders;
• disorders of the circulatory system;
• mental disorders accompanied by the patient's actions that pose an immediate danger to him or other persons;
• pain syndrome;
• injuries of any etiology, poisoning, wounds (accompanied by life-threatening bleeding or damage to internal organs);
• thermal and chemical burns;
• bleeding of any etiology;
• childbirth, threatened miscarriage.

As you can see, this is only an approximate list, but we believe that it can be used by analogy in the provision of other medical care (not emergency).

However, it follows from the analyzed acts that often the conclusion about the presence of a threat to life is made either by the victim himself or by the ambulance dispatcher, based on the subjective opinion and assessment of what is happening by the person who applied for help. In such a situation, both an overestimation of the danger to life and a clear underestimation of the severity of the patient's condition are possible.

I would like to hope that the most important details will soon be spelled out in more "full" volume in the acts. At the moment, medical organizations probably still should not ignore the medical understanding of the urgency of the situation, the presence of a threat to the life of the patient and the urgency of action. In a medical organization, it is mandatory (or rather, strongly recommendatory) to develop local instructions for emergency medical care on the territory of the organization, which all medical workers should be familiar with.

Article 20 of Law No. 323-FZ states that a necessary precondition for medical intervention is the giving of informed voluntary consent (hereinafter referred to as IDS) of a citizen or his legal representative for medical intervention on the basis of complete information provided by a medical worker in an accessible form about the goals, methods of providing medical care the risks associated with them, possible options for medical intervention, its consequences, as well as the expected results of medical care.

However, the situation of medical care in emergency form(which is also considered a medical intervention) is exempt. Namely, medical intervention is allowed without the consent of the person for emergency reasons to eliminate the threat to human life, if the condition does not allow expressing one's will, or there are no legal representatives (paragraph 1 of part 9 of article 20 of the Federal Law No. 323). Similarly, the basis for the disclosure of medical confidentiality without the consent of the patient (paragraph 1 of part 4 of article 13 of the Federal Law No. 323).

In accordance with paragraph 10 of Article 83 of the Federal Law No. 323, the costs associated with the provision of free medical care to citizens in an emergency form by a medical organization, including a medical organization of a private healthcare system, are subject to reimbursement. For reimbursement of expenses for the provision of EMP, read our article: Reimbursement of expenses for the provision of free medical care in an emergency form.

After entry into force Order of the Ministry of Health of Russia dated March 11, 2013 No. 121n“On approval of the Requirements for the organization and performance of work (services) in the provision of primary health care, specialized (including high-tech) ...” (hereinafter - Order of the Ministry of Health No. 121n), many citizens have a well-founded misconception that emergency medical care must be included in the medical license. The type of medical service "emergency medical care", subject, is also indicated in Decree of the Government of the Russian Federation dated April 16, 2012 No. 291"On Licensing Medical Activities".

However, the Ministry of Health of the Russian Federation in its Letter No. 12-3 / 10 / 2-5338 dated July 23, 2013 gave the following explanation on this topic: “As for the work (service) in emergency medical care, this work (service) was introduced for licensing the activities of medical organizations that, in accordance with Part 7 of Article 33 of Federal Law N 323-FZ, have created units in their structure for the provision of primary health care in an emergency form. In other cases of providing medical care in an emergency form, obtaining a license providing for the performance of works (services) in emergency medical care is not required.

Thus, the type of medical service "emergency medical care" is subject to licensing only by those medical organizations, in the structure of which, in accordance with Article 33 of the Federal Law No. 323, medical care units are created that provide the specified assistance in an emergency form.

The article uses materials from the article Mokhov A.A. Peculiarities of emergency and emergency care in Russia // Legal issues in health care. 2011. No. 9.

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