Emergency conditions(accidents) - incidents, as a result of which harm is done to human health or there is a threat to his life. An emergency is characterized by suddenness: it can happen to anyone, at any time and in any place.

People injured in an accident need immediate medical attention. If there is a doctor, paramedic, or nurse turn to them for first aid. Otherwise, help should be provided by people who are close to the victim.

The severity of the consequences of an emergency, and sometimes the life of the victim, depends on the timeliness and correctness of actions to provide emergency medical care, so each person must have the skills to provide first aid in emergency conditions.

There are the following types of emergency conditions:

thermal injury;

poisoning;

Bites of poisonous animals;

Attacks of diseases;

Consequences of natural disasters;

Radiation damage, etc.

The set of measures required for victims in each type of emergency has a number of features that must be taken into account when providing assistance to them.

4.2. First aid for sun, heat stroke and fumes

Sunstroke called a lesion resulting from long-term exposure to sunlight on an unprotected head. Sunstroke can also be obtained when you stay outside for a long time on a clear day without a hat.

Heatstroke- this is excessive overheating of the whole organism as a whole. Heat stroke can also happen in cloudy, hot, windless weather - with long and hard physical work, long and difficult transitions, etc. Heat stroke is more likely when a person is not physically prepared enough and is very tired and thirsty.

Symptoms of sun and heat stroke are:

Cardiopalmus;

Redness, and then blanching of the skin;

violation of coordination;

Headache;

Noise in ears;

Dizziness;

Great weakness and lethargy;

Decrease in the intensity of the pulse and breathing;

Nausea, vomiting;

Nose bleed;

Sometimes convulsions and fainting.

The provision of first aid for sun and heat stroke should begin with the transportation of the victim to a place protected from heat exposure. In this case, it is necessary to lay the victim in such a way that his head is higher than the body. After that, the victim needs to provide free access to oxygen, loosen his clothes. To cool the skin, you can wipe the victim with water, cool the head with a cold compress. The victim should be given a cold drink. In severe cases, artificial respiration is necessary.

Fainting- This is a short-term loss of consciousness due to insufficient blood flow to the brain. Fainting can occur from severe fright, excitement, great fatigue, as well as from significant blood loss and a number of other reasons.

When fainting, a person loses consciousness, his face turns pale and covered with cold sweat, the pulse is barely palpable, breathing slows down and is often difficult to detect.

First aid for fainting comes down to improving the blood supply to the brain. For this, the victim is laid so that his head is lower than the body, and his legs and arms are somewhat raised. The victim's clothing must be loosened, his face is sprinkled with water.

It is necessary to ensure the flow of fresh air (open the window, fan the victim). To excite the breath, you can give a sniff of ammonia, and to enhance the activity of the heart, when the patient regains consciousness, give hot strong tea or coffee.

frenzy- poisoning of a person with carbon monoxide (CO). Carbon monoxide is formed when fuel burns without an adequate supply of oxygen. Carbon monoxide poisoning is unnoticeable because the gas is odorless. Symptoms of carbon monoxide poisoning include:

General weakness;

Headache;

Dizziness;

Drowsiness;

Nausea, then vomiting.

In severe poisoning, there are violations of cardiac activity and respiration. If the injured person is not helped, death may occur.

First aid for fumes comes down to the following. First of all, the victim must be removed from the zone of carbon monoxide or ventilate the room. Then you need to apply a cold compress to the head of the victim and let him smell the cotton wool moistened with ammonia. To improve cardiac activity, the victim is given a hot drink (strong tea or coffee). Heating pads are applied to the legs and arms or mustard plasters are placed. When fainting, give artificial respiration. After that, you should immediately seek medical help.

4.3. First aid for burns, frostbite and freezing

Burn- this is thermal damage to the integument of the body caused by contact with hot objects or reagents. A burn is dangerous because, under the influence of high temperature, the living protein of the body coagulates, i.e., living human tissue dies. The skin is designed to protect tissues from overheating, however, with prolonged action of the damaging factor, not only the skin suffers from the burn,

but also tissues, internal organs, bones.

Burns can be classified according to a number of criteria:

According to the source: burns by fire, hot objects, hot liquids, alkalis, acids;

According to the degree of damage: burns of the first, second and third degree;

By the size of the affected surface (as a percentage of the body surface).

With a first-degree burn, the burnt area turns slightly red, swells, and a slight burning sensation is felt. Such a burn heals within 2-3 days. A second-degree burn causes redness and swelling of the skin, blisters filled with a yellowish liquid appear on the burned area. The burn heals in 1 or 2 weeks. A third-degree burn is accompanied by necrosis of the skin, underlying muscles, and sometimes bone.

The danger of a burn depends not only on its degree, but also on the size of the damaged surface. Even a first-degree burn, if it covers half the surface of the entire body, is considered a serious disease. In this case, the victim experiences a headache, vomiting, diarrhea appear. The body temperature rises. These symptoms are caused by a general poisoning of the body due to the decay and decomposition of dead skin and tissues. With large burn surfaces, when the body is not able to remove all decay products, kidney failure may occur.

Second and third degree burns, if they affect a significant part of the body, can be fatal.

First health care with burns of the first and second degree, it is limited to applying a lotion of alcohol, vodka or a 1-2% solution of potassium permanganate (half a teaspoon to a glass of water) on the burnt place. In no case should you pierce the bubbles formed as a result of a burn.

If a third-degree burn occurs, a dry sterile bandage should be applied to the burnt area. In this case, it is necessary to remove the remnants of clothing from the burnt place. These actions must be performed very carefully: first, the clothes are cut off around the affected area, then the affected area is soaked with a solution of alcohol or potassium permanganate and only then removed.

With a burn acid the affected surface must be immediately washed with running water or a 1-2% soda solution (half a teaspoon per glass of water). After that, the burn is sprinkled with crushed chalk, magnesia or tooth powder.

When exposed to particularly strong acids (for example, sulfuric), washing with water or aqueous solutions can cause secondary burns. In this case, the wound should be treated with vegetable oil.

For burns caustic alkali the affected area is washed with running water or a weak solution of acid (acetic, citric).

frostbite- this is a thermal damage to the skin, caused by their strong cooling. Unprotected areas of the body are most susceptible to this type of thermal damage: ears, nose, cheeks, fingers and toes. The likelihood of frostbite increases when wearing tight shoes, dirty or wet clothes, with general exhaustion of the body, anemia.

There are four degrees of frostbite:

- I degree, in which the affected area turns pale and loses sensitivity. When the effect of cold ceases, the frostbite becomes bluish-red in color, becomes painful and swollen, and itching often appears;

- II degree, in which blisters appear on the frostbitten area after warming, the skin around the blisters has a bluish-red color;

- III degree, at which necrosis of the skin occurs. Over time, the skin dries out, a wound forms under it;

- IV degree, in which necrosis can spread to the tissues lying under the skin.

First aid for frostbite is to restore blood circulation in the affected area. The affected area is wiped with alcohol or vodka, lightly lubricated with petroleum jelly or unsalted fat and carefully rubbed with cotton or gauze so as not to damage the skin. You should not rub the frostbitten area with snow, as ice particles come across in the snow, which can damage the skin and facilitate the penetration of microbes.

Burns and blisters resulting from frostbite are similar to burns from exposure elevated temperature. Accordingly, the steps described above are repeated.

In the cold season, in severe frosts and snowstorms, it is possible general freezing of the body. Its first symptom is chilliness. Then a person develops fatigue, drowsiness, the skin turns pale, the nose and lips are cyanotic, breathing is barely noticeable, the activity of the heart gradually weakens, and an unconscious state is also possible.

First aid in this case comes down to warming the person and restoring his blood circulation. To do this, you need to bring it into a warm room, make, if possible, a warm bath and easily rub the frostbitten limbs with your hands from the periphery to the center until the body becomes soft and flexible. Then the victim must be put to bed, covered warmly, given hot tea or coffee to drink and a doctor called.

However, it should be noted that with prolonged exposure to cold air or in cold water all human blood vessels constrict. And then, due to a sharp heating of the body, blood can hit the vessels of the brain, which is fraught with a stroke. Therefore, heating a person must be done gradually.

4.4. First aid for food poisoning

Poisoning of the body can be caused by eating various poor-quality products: stale meat, jelly, sausages, fish, lactic acid products, canned food. It is also possible poisoning due to the use of inedible greens, wild berries, mushrooms.

The main symptoms of poisoning are:

General weakness;

Headache;

Dizziness;

Abdominal pain;

Nausea, sometimes vomiting.

In severe cases of poisoning, loss of consciousness, weakening of cardiac activity and respiration are possible, in the most severe cases - death.

First aid for poisoning begins with the removal of poisoned food from the stomach of the victim. To do this, they induce vomiting in him: give him 5-6 glasses of warm salted or soda water to drink, or insert two fingers deep into the throat and press on the root of the tongue. This cleansing of the stomach must be repeated several times. If the victim is unconscious, his head must be turned to the side so that the vomit does not enter the respiratory tract.

In case of poisoning with strong acid or alkali, it is impossible to induce vomiting. In such cases, the victim should be given oatmeal or linseed broth, starch, raw eggs, sunflower or butter.

The poisoned person should not be allowed to fall asleep. To eliminate drowsiness, you need to spray the victim cold water or drink strong tea. In case of convulsions, the body is warmed with heating pads. After providing first aid, the poisoned person must be taken to the doctor.

4.5. First aid for poisoning

TO toxic substances(OS) refers to chemical compounds capable of infecting unprotected people and animals, leading to their death or incapacitating them. The action of agents can be based on ingestion through the respiratory system (inhalation exposure), penetration through the skin and mucous membranes (resorption) or through gastrointestinal tract by ingestion of contaminated food and water. Poisonous substances act in drop-liquid form, in the form of aerosols, vapor or gas.

As a rule, agents are an integral part of chemical weapons. Chemical weapons are understood as military means, the damaging effect of which is based on the toxic effects of OM.

Poisonous substances that are part of chemical weapons have a number of features. They are capable of causing massive damage to people and animals in a short time, destroying plants, infecting large volumes of surface air, which leads to the defeat of people on the ground and uncovered people. For a long time, they can retain their damaging effect. The delivery of such agents to their destinations is carried out in several ways: with the help of chemical bombs, aircraft pouring devices, aerosol generators, rockets, rocket and artillery shells and mines.

First medical aid in case of OS damage should be carried out in the order of self-help and mutual assistance or specialized services. When providing first aid, you must:

1) immediately put on a gas mask on the victim (or replace the damaged gas mask with a serviceable one) to stop the effect of the damaging factor on the respiratory system;

2) quickly introduce an antidote (specific drug) to the victim using a syringe tube;

3) sanitize all exposed skin areas of the victim with a special liquid from an individual anti-chemical package.

The syringe tube consists of a polyethylene body, on which a cannula with an injection needle is screwed. The needle is sterile, it is protected from contamination by a cap tightly put on the cannula. The body of the syringe tube is filled with an antidote or other drug and hermetically sealed.

To administer the drug using a syringe tube, you must perform the following steps.

1. Using the thumb and forefinger of the left hand, grasp the cannula, and with the right hand support the body, then turn the body clockwise until it stops.

2. Make sure there is medicine in the tube (to do this, press the tube without removing the cap).

3. Remove the cap from the syringe, while turning it a little; squeeze the air out of the tube by pressing it until a drop of liquid appears at the tip of the needle.

4. Sharply (with a stabbing motion) insert the needle under the skin or into the muscle, after which all the liquid contained in it is squeezed out of the tube.

5. Without opening your fingers on the tube, remove the needle.

When administering an antidote, it is best to inject into the buttock (upper outer quadrant), anterolateral thigh, and outer surface shoulder. In an emergency, at the site of the lesion, the antidote is administered using a syringe tube and through clothing. After the injection, you need to attach an empty syringe tube to the victim’s clothing or put it in the right pocket, which will indicate that the antidote has been entered.

Sanitary treatment of the skin of the victim is carried out with a liquid from an individual anti-chemical package (IPP) directly at the site of the lesion, as this allows you to quickly stop exposure to toxic substances through unprotected skin. The PPI includes a flat bottle with a degasser, gauze swabs and a case (polyethylene bag).

When treating exposed skin with PPIs, follow these steps:

1. Open the package, take a swab from it and moisten it with the liquid from the package.

2. Wipe the exposed areas of the skin and the outer surface of the gas mask with a swab.

3. Re-moisten the swab and wipe the edges of the collar and the edges of the cuffs of the clothing that come into contact with the skin.

Please note that PPI liquid is poisonous and if it enters the eyes, it may be harmful to health.

If the agents are sprayed in an aerosol way, then the entire surface of the clothing will be contaminated. Therefore, after leaving the affected area, you should immediately take off your clothes, since the OM contained on it can cause damage due to evaporation into the breathing zone, penetration of vapors into the space under the suit.

In case of damage to the nerve agents of the nerve agent, the victim must be immediately evacuated from the source of infection to a safe area. During the evacuation of the affected, it is necessary to monitor their condition. To prevent seizures, repeated administration of the antidote is allowed.

If the affected person vomits, turn his head to the side and pull off the lower part of the gas mask, then put the gas mask back on. If necessary, the contaminated gas mask is replaced with a new one.

At negative ambient temperatures, it is important to protect the valve box of the gas mask from freezing. To do this, it is covered with a cloth and systematically warmed up.

In case of damage to asphyxiating agents (sarin, carbon monoxide, etc.), the victims are given artificial respiration.

4.6. First aid for a drowning person

A person cannot live without oxygen for more than 5 minutes, therefore, falling under water and being there for a long time, a person can drown. The causes of this situation can be different: cramps in the limbs when swimming in water bodies, exhaustion of strength during long swims, etc. Water, getting into the mouth and nose of the victim, fills the airways, and suffocation occurs. Therefore, assistance to a drowning person must be provided very quickly.

First aid to a drowning person begins with removing him to a hard surface. We especially note that the rescuer must be a good swimmer, otherwise both the drowning person and the rescuer may drown.

If the drowning man himself tries to stay on the surface of the water, he must be encouraged, a lifebuoy, a pole, an oar, the end of a rope should be thrown to him so that he can stay on the water until he is rescued.

The rescuer must be without shoes and clothes, in extreme cases without outerwear. You need to swim up to the drowning man carefully, preferably from behind, so that he does not grab the rescuer by the neck or by the arms and pull him to the bottom.

A drowning person is taken from behind under the armpits or by the back of the head near the ears and, holding the face above the water, they swim on their backs to the shore. You can grab a drowning person with one hand around the waist, only from behind.

Needed on the beach restore breathing the victim: quickly take off his clothes; free your mouth and nose from sand, dirt, silt; remove water from the lungs and stomach. Then the following steps are taken.

1. The first aid provider gets on one knee, puts the victim on the second knee with his stomach down.

2. The hand presses on the back between the shoulder blades of the victim until the foamy liquid stops flowing out of his mouth.

4. When the victim regains consciousness, he must be warmed by rubbing the body with a towel or overlaying it with heating pads.

5. To enhance cardiac activity, the victim is given strong hot tea or coffee to drink.

6. Then the victim is transported to a medical facility.

If a drowning person has fallen through the ice, then it is impossible to run to help him on the ice when he is not strong enough, since the rescuer can also drown. You need to put a board or ladder on the ice and, carefully approaching, throw the end of the rope to the drowning person or stretch out a pole, oar, stick. Then, just as carefully, you need to help him get to the shore.

4.7. First aid for bites of poisonous insects, snakes and rabid animals

In the summer, a person can be stung by a bee, wasp, bumblebee, snake, and in some areas - a scorpion, tarantula or other poisonous insects. The wound from such bites is small and resembles a needle prick, but when bitten, poison penetrates through it, which, depending on its strength and quantity, either acts first on the area of ​​\u200b\u200bthe body around the bite, or immediately causes general poisoning.

Single bites bees, wasps And bumblebees pose no particular danger. If a sting remains in the wound, it must be carefully removed, and a lotion of ammonia with water or a cold compress from a solution of potassium permanganate or simply cold water should be put on the wound.

bites poisonous snakes life-threatening. Usually snakes bite a person in the leg when he steps on them. Therefore, in places where snakes are found, you can not walk barefoot.

When bitten by a snake, the following symptoms are observed: burning pain at the site of the bite, redness, swelling. After half an hour, the leg can almost double in volume. At the same time, signs of general poisoning appear: loss of strength, muscle weakness, dizziness, nausea, vomiting, weak pulse, sometimes loss of consciousness.

bites poisonous insects very dangerous. Their poison causes not only severe pain and burning at the site of the bite, but sometimes general poisoning. The symptoms are reminiscent of poisoning by snake venom. In case of severe poisoning with the poison of a karakurt spider, death may occur in 1-2 days.

First aid for the bite of poisonous snakes and insects is as follows.

1. Above the bitten place, it is necessary to apply a tourniquet or twist to prevent the poison from entering the rest of the body.

2. The bitten limb must be lowered and try to squeeze out the blood from the wound, in which the poison is located.

You can not suck blood from the wound with your mouth, as there may be scratches or broken teeth in the mouth, through which the poison will penetrate into the blood of the one who provides assistance.

You can draw blood along with poison from the wound using a medical jar, glass or glass with thick edges. To do this, in a jar (glass or glass), you need to hold a lit splinter or cotton wool on a stick for several seconds and then quickly cover the wound with it.

Each victim of a snake bite and poisonous insects must be transported to a medical facility.

From the bite of a rabid dog, cat, fox, wolf or other animal, a person becomes ill rabies. The bite site usually bleeds slightly. If an arm or leg is bitten, it must be quickly lowered and try to squeeze the blood out of the wound. When bleeding, the blood should not be stopped for some time. After that, the bite site is washed with boiled water, a clean bandage is applied to the wound and the patient is immediately sent to a medical facility, where the victim is given special vaccinations that will save him from a deadly disease - rabies.

It should also be remembered that rabies can be contracted not only from the bite of a rabid animal, but also in cases where its saliva gets on scratched skin or mucous membranes.

4.8. First aid for electric shock

Electric shocks are dangerous to human life and health. High voltage current can cause instant loss of consciousness and lead to death.

The voltage in the wires of residential premises is not so high, and if at home you carelessly grab a bare or poorly insulated electrical wire, pain and convulsive contraction of the muscles of the fingers are felt in the hand, and a small superficial burn of the upper skin can form. Such a defeat does not bring much harm to health and is not life-threatening if there is grounding in the house. If there is no grounding, then even a small current can lead to undesirable consequences.

A current of a stronger voltage causes convulsive contraction of the muscles of the heart, blood vessels, and respiratory organs. In such cases, there is a violation of blood circulation, a person may lose consciousness, while he turns pale sharply, his lips turn blue, breathing becomes barely noticeable, the pulse is palpable with difficulty. In severe cases, there may be no signs of life at all (breathing, heartbeat, pulse). There comes the so-called "imaginary death". In this case, a person can be brought back to life if he is immediately given first aid.

First aid in case of electric shock should begin with the termination of the current on the victim. If a broken bare wire falls on a person, it must be immediately discarded. This can be done with any object that conducts electricity poorly (a wooden stick, a glass or plastic bottle, etc.). If an accident occurs indoors, you must immediately turn off the switch, unscrew the plugs or simply cut the wires.

It should be remembered that the rescuer must take the necessary measures so that he himself does not suffer from the effects of electric current. To do this, when providing first aid, you need to wrap your hands with a non-conductive cloth (rubber, silk, woolen), put on dry rubber shoes on your feet or stand on a pack of newspapers, books, a dry board.

You can not take the victim by the naked parts of the body while the current continues to act on him. When removing the victim from the wire, you should protect yourself by wrapping your hands with an insulating cloth.

If the victim is unconscious, he must first be brought to his senses. To do this, you need to unbutton his clothes, sprinkle water on him, open windows or doors and give him artificial respiration - until spontaneous breathing appears and consciousness returns. Sometimes artificial respiration has to be done continuously for 2-3 hours.

Simultaneously with artificial respiration, the body of the victim must be rubbed and warmed with heating pads. When consciousness returns to the victim, he is put to bed, covered warmly and given a hot drink.

A patient with an electric shock may have various complications, so he must be sent to the hospital.

Another possible option for the impact of electric current on a person is lightning strike, the action of which is similar to the action of an electric current of very high voltage. In some cases, the affected person instantly dies from respiratory paralysis and cardiac arrest. Red streaks appear on the skin. However, being struck by lightning often comes down to nothing more than a severe stun. In such cases, the victim loses consciousness, his skin turns pale and cold, the pulse is barely palpable, breathing is shallow, barely noticeable.

Saving the life of a person struck by lightning depends on the speed of first aid. The victim should immediately start artificial respiration and continue it until he begins to breathe on his own.

To prevent the effects of lightning, a number of measures must be observed during rain and thunderstorms:

It is impossible during a thunderstorm to hide from the rain under a tree, as the trees "attract" a lightning bolt to themselves;

Elevated areas should be avoided during thunderstorms, as in these places the probability of a lightning strike is higher;

All residential and administrative premises must be equipped with lightning rods, the purpose of which is to prevent lightning from entering the building.

4.9. Complex of cardiopulmonary resuscitation. Its application and performance criteria

Cardiopulmonary resuscitation- a set of measures aimed at restoring cardiac activity and respiration of the victim when they stop (clinical death). This can happen with electric shock, drowning, in a number of other cases with squeezing or blockage. respiratory tract. The probability of survival of the patient directly depends on the speed of resuscitation.

It is most effective to use special devices for artificial ventilation of the lungs, with the help of which air is blown into the lungs. In the absence of such devices, artificial ventilation of the lungs is carried out in various ways, of which the most common is the mouth-to-mouth method.

The method of artificial ventilation of the lungs "mouth to mouth". To assist the victim, it is necessary to lay him on his back so that the airways are free for the passage of air. To do this, his head must be thrown back as much as possible. If the jaws of the victim are strongly compressed, it is necessary to push the lower jaw forward and, pressing on the chin, open the mouth, then clean it with a napkin oral cavity from saliva or vomit and start artificial ventilation of the lungs:

1) put a napkin (handkerchief) in one layer on the open mouth of the victim;

2) pinch his nose;

3) take a deep breath;

4) tightly press your lips to the lips of the victim, creating tightness;

5) blow air into his mouth with force.

Air is blown rhythmically 16-18 times per minute until natural breathing is restored.

In case of injuries of the lower jaw, artificial ventilation of the lungs can be performed in a different way, when air is blown through the victim's nose. His mouth must be closed.

Artificial ventilation of the lungs is stopped when reliable signs of death are established.

Other methods of artificial lung ventilation. With extensive injuries of the maxillofacial region, artificial ventilation of the lungs using the mouth-to-mouth or mouth-to-nose methods cannot be performed, therefore, the methods of Sylvester and Kallistov are used.

During artificial lung ventilation Sylvester's way the victim lies on his back, assisting him kneels at his head, takes both his hands by the forearms and sharply raises them, then takes them back behind him and spreads them apart - this is how a breath is made. Then, with a reverse movement, the victim's forearms are placed on the lower part chest and squeeze it - this is how the exhalation occurs.

With artificial lung ventilation Kallistov's way the victim is laid on his stomach with arms extended forward, his head is turned to one side, putting clothes (blanket) under it. With stretcher straps or tied with two or three trouser belts, the victim is periodically (in the rhythm of breathing) raised to a height of up to 10 cm and lowered. When lifting the affected as a result of straightening his chest, inhalation occurs, when lowered due to its compression, exhalation occurs.

Signs of cardiac arrest and indirect massage hearts. Signs of cardiac arrest are:

Absence of pulse, palpitations;

Lack of pupillary response to light (dilated pupils).

Once these symptoms are identified, immediate action should be taken. indirect heart massage. For this:

1) the victim is laid on his back, on a hard, hard surface;

2) standing on the left side of him, put their palms one on top of the other on the region of the lower third of the sternum;

3) with energetic rhythmic pushes 50–60 times per minute, they press on the sternum, after each push, releasing their hands to allow the chest to expand. The anterior chest wall should be displaced to a depth of at least 3–4 cm.

An indirect heart massage is performed in combination with artificial ventilation of the lungs: 4-5 pressures on the chest (on exhalation) alternate with one blowing of air into the lungs (inhalation). In this case, the victim should be assisted by two or three people.

Artificial ventilation of the lungs in combination with chest compressions - the simplest way resuscitation(revival) of a person who is in a state of clinical death.

Signs of the effectiveness of the measures taken are the appearance of a person’s spontaneous breathing, the restored complexion, the appearance of a pulse and heartbeat, as well as a return to the sick consciousness.

After carrying out these activities, the patient must be provided with peace, he must be warmed, given a hot and sweet drink, and if necessary, apply tonics.

When carrying out artificial ventilation of the lungs and indirect heart massage, the elderly should remember that the bones at this age are more fragile, so the movements should be gentle. For small children, indirect massage is performed by pressing in the sternum area not with the palms, but with a finger.

4.10. Provision of medical assistance in case of natural disasters

natural disaster called an emergency situation in which human casualties and material losses are possible. There are natural emergencies (hurricanes, earthquakes, floods, etc.) and anthropogenic (bomb explosions, accidents at enterprises) origin.

Sudden natural disasters and accidents require urgent medical assistance to the affected population. Of great importance are the timely provision of first aid directly at the site of injury (self-help and mutual assistance) and the evacuation of victims from the outbreak to medical facilities.

The main type of injury in natural disasters is trauma, accompanied by life-threatening bleeding. Therefore, it is first necessary to take measures to stop bleeding, and then provide symptomatic medical care to the victims.

The content of measures to provide medical care to the population depends on the type of natural disaster, accident. Yes, at earthquakes this is the extraction of victims from the rubble, the provision of medical assistance to them, depending on the nature of the injury. At floods the first priority is to remove the victims from the water, warm them, stimulate cardiac and respiratory activity.

In the area affected tornado or hurricane, it is important to quickly carry out medical triage of the affected, to provide assistance first of all to those most in need.

affected as a result snow drifts And collapses after being removed from under the snow, they warm them, then provide them with the necessary assistance.

In the outbreaks fires first of all, it is necessary to extinguish burning clothes on the victims, apply sterile dressings to the burned surface. If people are affected by carbon monoxide, immediately remove them from areas of intense smoke.

When accidents at nuclear power plants it is necessary to organize a radiation reconnaissance, which will make it possible to determine the levels of radioactive contamination of the territory. Food, food raw materials, water should be subjected to radiation control.

Providing assistance to the victims. In the event of a lesion, the victims are provided with the following types of assistance:

First aid;

First medical aid;

Qualified and specialized medical care.

First aid is provided directly to the affected person at the site of injury by sanitary teams and sanitary posts, other units of the Russian Emergencies Ministry working in the outbreak, as well as in the order of self- and mutual assistance. Its main task is to save the life of the affected person and prevent possible complications. Removal of the injured to the places of loading onto transport is carried out by the porters of the rescue units.

The first medical aid to the injured is provided by medical units, medical units of military units and health care facilities that have been preserved in the outbreak. All these formations constitute the first stage of medical and evacuation support for the affected population. The tasks of first medical aid are to maintain the vital activity of the affected organism, prevent complications and prepare it for evacuation.

Qualified and specialized medical care for the injured is provided in medical institutions.

4.11. Medical care for radiation contamination

When providing first aid to victims of radiation contamination, it must be taken into account that in the contaminated area it is impossible to eat food, water from contaminated sources, or touch objects contaminated with radioactive substances. Therefore, first of all, it is necessary to determine the procedure for preparing food and purifying water in contaminated areas (or organizing delivery from uncontaminated sources), taking into account the level of contamination of the area and the current situation.

First medical aid to victims of radiation contamination should be provided under conditions of maximum reduction of harmful effects. To do this, the victims are transported to an uninfected area or to special shelters.

Initially, it is necessary to take certain actions to save the life of the victim. First of all, it is necessary to organize sanitization and partial decontamination of his clothes and shoes to prevent harmful effects on the skin and mucous membranes. To do this, they wash with water and wipe the exposed skin of the victim with wet swabs, wash their eyes, and rinse their mouth. When decontaminating clothes and shoes, you must use personal protection to prevent the harmful effects of radioactive substances on the victim. It is also necessary to prevent contact of contaminated dust with other people.

If necessary, gastric lavage of the victim is carried out, absorbent agents (activated charcoal, etc.) are used.

Medical prophylaxis of radiation injuries is carried out with radioprotective agents available in an individual first-aid kit.

The individual first-aid kit (AI-2) contains a set of medical supplies intended for personal prevention of injuries by radioactive, poisonous substances and bacterial agents. In case of radiation contamination, the following drugs contained in AI-2 are used:

- I nest - a syringe tube with an analgesic;

- III nest - antibacterial agent No. 2 (in an oblong pencil case), 15 tablets in total, which are taken after radiation exposure for gastrointestinal disorders: 7 tablets per dose on the first day and 4 tablets per dose daily for the next two days. The drug is taken to prevent infectious complications that may occur due to the weakening of the protective properties of the irradiated organism;

- IV nest - radioprotective agent No. 1 (pink cases with a white lid), 12 tablets in total. Take 6 tablets at the same time 30-60 minutes before the start of irradiation according to the civil defense warning signal in order to prevent radiation damage; then 6 tablets after 4-5 hours while in the territory contaminated with radioactive substances;

- VI slot - radioprotective agent No. 2 (white pencil case), 10 tablets in total. Take 1 tablet daily for 10 days when eating contaminated foods;

- VII nest - antiemetic (blue pencil case), 5 tablets in total. Use 1 tablet for contusions and primary radiation reaction to prevent vomiting. For children under the age of 8 years, take one fourth of the indicated dose, for children from 8 to 15 years old - half the dose.

Distribution medical preparations and instructions for their use are attached to an individual first-aid kit.

SUDDEN DEATH

Diagnostics. Lack of consciousness and pulse on the carotid arteries, a little later - the cessation of breathing.

In the process of carrying out CPR - according to the ECP, ventricular fibrillation (in 80% of cases), asystole or electromechanical dissociation (in 10-20% of cases). If emergency ECG registration is not possible, they are guided by the manifestations of the onset of clinical death and the response to CPR.

Ventricular fibrillation develops suddenly, the symptoms appear sequentially: the disappearance of the pulse in the carotid arteries and loss of consciousness; a single tonic contraction of the skeletal muscles; violations and respiratory arrest. The response to timely CPR is positive, to the termination of CPR - fast negative.

With advanced SA- or AV-blockade, the symptoms develop relatively gradually: clouding of consciousness => motor excitation => moaning => tonic-clonic convulsions => respiratory disorders (MAS syndrome). When conducting a closed heart massage - a quick positive effect that persists for some time after the cessation of CPR.

Electromechanical dissociation in massive PE occurs suddenly (often at the time of physical exertion) and is manifested by the cessation of breathing, the absence of consciousness and pulse on the carotid arteries, and a sharp cyanosis of the skin of the upper half of the body. swelling of the neck veins. With the timely start of CPR, signs of its effectiveness are determined.

Electromechanical dissociation in myocardial rupture, cardiac tamponade develops suddenly (often after severe anginal syndrome), without convulsive syndrome, there are no signs of CPR effectiveness. Hypostatic spots quickly appear on the back.

Electromechanical dissociation due to other causes (hypovolemia, hypoxia, tension pneumothorax, overdose medicines, increasing cardiac tamponade) does not occur suddenly, but develops against the background of the progression of the corresponding symptoms.

Urgent Care :

1. With ventricular fibrillation and the impossibility of immediate defibrillation:

Apply a precordial strike: Cover the xiphoid process with two fingers to protect it from damage. It is located at the bottom of the sternum, where the lower ribs converge, and can break off with a sharp blow and injure the liver. Inflict a pericardial blow with the edge of a palm clenched into a fist slightly above the xiphoid process covered with fingers. It looks like this: with two fingers of one hand you cover the xiphoid process, and with the fist of the other hand strike (while the elbow of the hand is directed along the body of the victim).

After that, check the pulse on the carotid artery. If the pulse does not appear, then your actions are not effective.

No effect - start CPR immediately, ensure that defibrillation is possible as soon as possible.

2. Closed heart massage should be performed at a frequency of 90 per 1 min with a compression-decompression ratio of 1:1: the method of active compression-decompression (using a cardiopamp) is more effective.

3. GOING in an accessible way (the ratio of massage movements and breathing is 5:1, and with the work of one doctor - 15:2), ensure the patency of the airways (tilt back the head, push the lower jaw, insert the air duct, sanitize the airways according to indications);

Use 100% oxygen:

Intubate the trachea (no more than 30 s);

Do not interrupt cardiac massage and ventilation for more than 30 s.

4. Catheterize a central or peripheral vein.

5. Adrenaline 1 mg every 3 minutes of CPR (how to administer here and below - see note).

6. As soon as possible - defibrillation 200 J;

No effect - defibrillation 300 J:

No effect - defibrillation 360 J:

No effect - see point 7.

7. Act according to the scheme: the drug - heart massage and mechanical ventilation, after 30-60 s - defibrillation 360 J:

Lidocaine 1.5 mg/kg - defibrillation 360 J:

No effect - after 3 minutes, repeat the injection of lidocaine at the same dose and defibrillation of 360 J:

No effect - Ornid 5 mg/kg - defibrillation 360 J;

No effect - after 5 minutes, repeat the injection of Ornid at a dose of 10 mg / kg - defibrillation 360 J;

No effect - novocainamide 1 g (up to 17 mg / kg) - defibrillation 360 J;

No effect - magnesium sulfate 2 g - defibrillation 360 J;

In pauses between discharges, conduct a closed heart massage and mechanical ventilation.

8. With asystole:

If it is impossible to accurately assess the electrical activity of the heart (do not exclude the atonic stage of ventricular fibrillation) - act. as in ventricular fibrillation (items 1-7);

If asystole is confirmed in two ECG leads, perform steps. 2-5;

No effect - atropine after 3-5 minutes, 1 mg until an effect is obtained or a total dose of 0.04 mg / kg is reached;

EKS as soon as possible;

correct possible cause asystole (hypoxia, hypo- or hyperkalemia, acidosis, drug overdose, etc.);

The introduction of 240-480 mg of aminophylline can be effective.

9. With electromechanical dissociation:

Execute pp. 2-5;

Identify and correct its possible cause (massive PE - see relevant recommendations: cardiac tamponade - pericardiocentesis).

10. Monitor vital functions (heart monitor, pulse oximeter).

11. Hospitalize after possible stabilization of the condition.

12. CPR may be terminated if:

In the course of the procedure, it turned out that CPR is not indicated:

There is a persistent asystole that is not amenable to drug exposure, or multiple episodes of asystole:

When using all available methods, there is no evidence of effective CPR within 30 minutes.

13. CPR may not be started:

In the terminal stage of an incurable disease (if the futility of CPR is documented in advance);

If more than 30 minutes have passed since the cessation of blood circulation;

With a previously documented refusal of the patient from CPR.

After defibrillation: asystole, ongoing or recurrent ventricular fibrillation, skin burn;

With mechanical ventilation: overflow of the stomach with air, regurgitation, aspiration of gastric contents;

With tracheal intubation: laryngo- and bronchospasm, regurgitation, damage to the mucous membranes, teeth, esophagus;

With closed heart massage: fracture of the sternum, ribs, lung damage, tension pneumothorax;

When puncturing the subclavian vein: bleeding, puncture of the subclavian artery, lymphatic duct, air embolism, tension pneumothorax:

With intracardiac injection: injection of drugs into the myocardium, damage coronary arteries, hemotamponade, lung injury, pneumothorax;

Respiratory and metabolic acidosis;

Hypoxic coma.

Note. In case of ventricular fibrillation and the possibility of immediate (within 30 s) defibrillation - defibrillation of 200 J, then proceed according to paragraphs. 6 and 7.

All drugs during CPR should be given rapidly intravenously.

When using a peripheral vein, mix the preparations with 20 ml of isotonic sodium chloride solution.

In the absence of venous access, adrenaline, atropine, lidocaine (increasing the recommended dose by 2 times) should be injected into the trachea in 10 ml of isotonic sodium chloride solution.

Intracardiac injections (with a thin needle, with strict observance of the technique of administration and control) are permissible in exceptional cases, with the absolute impossibility of using other routes of drug administration.

Sodium bicarbonate at 1 mmol / kg (4% solution - 2 ml / kg), then at 0.5 mmol / kg every 5-10 minutes, apply with very long CPR or with hyperkalemia, acidosis, an overdose of tricyclic antidepressants, hypoxic lactic acidosis that preceded the cessation of blood circulation ( exclusively under conditions of adequate ventilation1).

Calcium preparations are indicated only for severe initial hyperkalemia or an overdose of calcium antagonists.

In treatment-resistant ventricular fibrillation, reserve drugs are amiodarone and propranolol.

In case of asystole or electromechanical dissociation after tracheal intubation and administration of drugs, if the cause cannot be eliminated, decide on the termination of resuscitation measures, taking into account the time elapsed from the onset of circulatory arrest.

CARDIAC EMERGENCIES tachyarrhythmias

Diagnostics. Severe tachycardia, tachyarrhythmia.

Differential Diagnosis- ECG. It is necessary to distinguish between non-paroxysmal and paroxysmal tachycardias: tachycardias with a normal duration of the OK8 complex (supraventricular tachycardias, atrial fibrillation and flutter) and tachycardias with a wide 9K8 complex on the ECG (supraventricular tachycardias, atrial fibrillation, atrial flutter with transient or permanent blockade of the bundle pedicle P1ca: antidromic supraventricular pouch tachycardias ; atrial fibrillation in the syndrome of IgP\V; ventricular tachycardia).

Urgent Care

Emergency restoration of sinus rhythm or correction of heart rate is indicated for tachyarrhythmias complicated by acute circulatory disorders, with a threat of cessation of blood circulation, or with repeated paroxysms of tachyarrhythmias with a known method of suppression. In other cases, it is necessary to ensure intensive monitoring and planned treatment(emergency hospitalization).

1. In case of cessation of blood circulation - CPR according to the recommendations of “Sudden Death”.

2. Shock or pulmonary edema (caused by tachyarrhythmia) are absolute vital indications for EIT:

Carry out oxygen therapy;

If the patient's condition allows, then premedicate (fentanyl 0.05 mg or promedol 10 mg intravenously);

Enter into drug sleep (diazepam 5 mg intravenously and 2 mg every 1-2 minutes before falling asleep);

Control your heart rate:

Perform EIT (with atrial flutter, supraventricular tachycardia, start with 50 J; with atrial fibrillation, monomorphic ventricular tachycardia - from 100 J; with polymorphic ventricular tachycardia - from 200 J):

If the patient's condition allows, synchronize the electrical impulse during EIT with the K wave on the ECL

Use well-moistened pads or gel;

At the moment of applying the discharge, press the electrodes against the chest wall with force:

Apply a discharge at the moment of exhalation of the patient;

Comply with safety regulations;

No effect - repeat EIT, doubling the discharge energy:

No effect - repeat EIT with a maximum energy discharge;

No effect - inject an antiarrhythmic drug indicated for this arrhythmia (see below) and repeat EIT with a maximum energy discharge.

3. In case of clinically significant circulatory disorders (arterial hypotension, anginal pain, increasing heart failure or neurological symptoms) or in case of repeated paroxysms of arrhythmia with a known method of suppression, urgent drug therapy should be carried out. In the absence of effect, deterioration of the condition (and in the cases indicated below - and as an alternative drug treatment) - EIT (item 2).

3.1. With paroxysm of reciprocal supraventricular tachycardia:

Massage of the carotid sinus (or other vagal techniques);

No effect - inject ATP 10 mg intravenously with a push:

No effect - after 2 minutes ATP 20 mg intravenously with a push:

No effect - after 2 minutes verapamil 2.5-5 mg intravenously:

No effect - after 15 minutes verapamil 5-10 mg intravenously;

A combination of ATP or verapamil administration with vagal techniques may be effective:

No effect - after 20 minutes novocainamide 1000 mg (up to 17 mg / kg) intravenously at a rate of 50-100 mg / min (with a tendency to arterial hypotension - in one syringe with 0.25-0.5 ml of 1% mezaton solution or 0.1-0.2 ml of 0.2% norepinephrine solution).

3.2. With paroxysmal atrial fibrillation to restore sinus rhythm:

Novocainamide (clause 3.1);

With a high initial heart rate: first intravenously 0.25-0.5 mg of digoxin (strophanthin) and after 30 minutes - 1000 mg of novocainamide. To reduce heart rate:

Digoxin (strophanthin) 0.25-0.5 mg, or verapamil 10 mg intravenously slowly or 80 mg orally, or digoxin (strophanthin) intravenously and verapamil orally, or anaprilin 20-40 mg under the tongue or inside.

3.3. With paroxysmal atrial flutter:

If EIT is not possible, decrease in heart rate with the help of digoxin (strophanthin) and (or) verapamil (section 3.2);

To restore sinus rhythm, novo-cainamide after a preliminary injection of 0.5 mg of digoxin (strophanthin) may be effective.

3.4. With paroxysm of atrial fibrillation against the background of IPU syndrome:

Intravenous slow novocainamide 1000 mg (up to 17 mg/kg), or amiodarone 300 mg (up to 5 mg/kg). or rhythmylen 150 mg. or aimalin 50 mg: either EIT;

cardiac glycosides. blockers of p-adrenergic receptors, calcium antagonists (verapamil, diltazem) are contraindicated!

3.5. With paroxysm of antidromic reciprocal AV tachycardia:

Intravenously slowly novocainamide, or amiodarone, or aymalin, or rhythmylen (section 3.4).

3.6. In case of tactic arrhythmias against the background of SSSU to reduce heart rate:

Intravenously slowly 0.25 mg of digoxin (strophan tin).

3.7. With paroxysmal ventricular tachycardia:

Lidocaine 80-120 mg (1-1.5 mg/kg) and every 5 minutes at 40-60 mg (0.5-0.75 mg/kg) slowly intravenously until the effect or a total dose of 3 mg/kg is reached:

No effect - EIT (p. 2). or novocainamide. or amiodarone (section 3.4);

No effect - EIT or magnesium sulfate 2 g intravenously very slowly:

No effect - EIT or Ornid 5 mg/kg intravenously (for 5 minutes);

No effect - EIT or after 10 minutes Ornid 10 mg/kg intravenously (for 10 minutes).

3.8. With bidirectional spindle tachycardia.

EIT or intravenously slowly introduce 2 g of magnesium sulfate (if necessary, magnesium sulfate is administered again after 10 minutes).

3.9. In case of paroxysm of tachycardia of unknown origin with wide complexes 9K5 on the ECG (if there are no indications for EIT), administer intravenous lidocaine (section 3.7). no effect - ATP (p. 3.1) or EIT, no effect - novocainamide (p. 3.4) or EIT (p. 2).

4. In all cases of acute cardiac arrhythmia (except for repeated paroxysms with restored sinus rhythm), emergency hospitalization is indicated.

5. Continuously monitor heart rate and conduction.

Cessation of blood circulation (ventricular fibrillation, asystole);

MAC syndrome;

Acute heart failure (pulmonary edema, arrhythmic shock);

arterial hypotension;

Respiratory failure with the introduction of narcotic analgesics or diazepam;

Skin burns during EIT:

Thromboembolism after EIT.

Note. emergency treatment arrhythmias should be carried out only according to the indications given above.

If possible, the cause of the arrhythmia and its supporting factors should be addressed.

Emergency EIT with heart rate less than 150 in 1 min is usually not indicated.

With severe tachycardia and no indications for urgent restoration of sinus rhythm, it is advisable to reduce the heart rate.

If there are additional indications, before the introduction of antiarrhythmic drugs, potassium and magnesium preparations should be used.

With paroxysmal atrial fibrillation, the appointment of 200 mg of phencarol inside can be effective.

An accelerated (60-100 beats per minute) idioventricular or AV junctional rhythm is usually replacement, and antiarrhythmic drugs are not indicated in these cases.

To provide emergency care for repeated, habitual paroxysms of tachyarrhythmia should take into account the effectiveness of the treatment of previous paroxysms and factors that can change the patient's response to the introduction of antiarrhythmic drugs that helped him before.

BRADIARRHYTHMIAS

Diagnostics. Severe (heart rate less than 50 per minute) bradycardia.

Differential Diagnosis- ECG. Sinus bradycardia, SA node arrest, SA and AV block should be differentiated: AV block should be distinguished by degree and level (distal, proximal); in the presence of an implanted pacemaker, it is necessary to evaluate the effectiveness of stimulation at rest, with a change in body position and load.

Urgent Care . Intensive therapy is necessary if bradycardia (heart rate less than 50 beats per minute) causes MAC syndrome or its equivalents, shock, pulmonary edema, arterial hypotension, anginal pain, or there is a progressive decrease in heart rate or an increase in ectopic ventricular activity.

2. With MAS syndrome or bradycardia that caused acute heart failure, arterial hypotension, neurological symptoms, anginal pain, or with a progressive decrease in heart rate or an increase in ectopic ventricular activity:

Lay the patient with the lower limbs raised at an angle of 20 ° (if there is no pronounced stagnation in the lungs):

Carry out oxygen therapy;

If necessary (depending on the patient's condition) - closed heart massage or rhythmic tapping on the sternum ("fist rhythm");

Administer atropine 1 mg intravenously every 3-5 minutes until an effect is obtained or a total dose of 0.04 mg/kg is reached;

No effect - immediate endocardial percutaneous or transesophageal pacemaker:

There is no effect (or there is no possibility of conducting an EX-) - intravenous slow jet injection of 240-480 mg of aminophylline;

No effect - dopamine 100 mg or adrenaline 1 mg in 200 ml of 5% glucose solution intravenously; gradually increase the infusion rate until the minimum sufficient heart rate is reached.

3. Continuously monitor heart rate and conduction.

4. Hospitalize after possible stabilization of the condition.

The main dangers in complications:

asystole;

Ectopic ventricular activity (up to fibrillation), including after the use of adrenaline, dopamine. atropine;

Acute heart failure (pulmonary edema, shock);

Arterial hypotension:

Anginal pain;

Impossibility or inefficiency of EX-

Complications of endocardial pacemaker (ventricular fibrillation, perforation of the right ventricle);

Pain during transesophageal or percutaneous pacemaker.

UNSTABLE ANGINA

Diagnostics. The appearance of frequent or severe anginal attacks (or their equivalents) for the first time, a change in the course of pre-existing angina pectoris, the resumption or appearance of angina pectoris in the first 14 days of myocardial infarction, or the appearance of anginal pain for the first time at rest.

There are risk factors for developing or clinical manifestations ischemic heart disease. Changes on the ECG, even at the height of the attack, may be vague or absent!

Differential diagnosis. In most cases - with prolonged exertional angina, acute myocardial infarction, cardialgia. extracardiac pain.

Urgent Care

1. Shown:

Nitroglycerin (tablets or aerosol 0.4-0.5 mg under the tongue repeatedly);

oxygen therapy;

Correction blood pressure and heart rate:

Propranolol (anaprilin, inderal) 20-40 mg orally.

2. With anginal pain (depending on its severity, age and condition of the patient);

Morphine up to 10 mg or neuroleptanalgesia: fentanyl 0.05-0.1 mg or promedol 10-20 mg with 2.5-5 mg droperidol intravenously fractionally:

With insufficient analgesia - intravenously 2.5 g of analgin, and with high blood pressure - 0.1 mg of clonidine.

5000 IU of heparin intravenously. and then drip 1000 IU / h.

5. Hospitalize after possible stabilization of the condition. Main dangers and complications:

Acute myocardial infarction;

Acute violations of the heart rhythm or conduction (up to sudden death);

Incomplete elimination or recurrence of anginal pain;

Arterial hypotension (including drug);

Acute heart failure:

Respiratory disorders with the introduction of narcotic analgesics.

Note. Emergency hospitalization is indicated, regardless of the presence of ECG changes, in intensive care units (wards), departments for the treatment of patients with acute myocardial infarction.

It is necessary to ensure constant monitoring of heart rate and blood pressure.

To provide emergency care(in the first hours of the disease or with complications), catheterization of a peripheral vein is indicated.

In case of recurrent anginal pain or moist rales in the lungs, nitroglycerin should be administered intravenously by drip.

For the treatment of unstable angina, the rate of intravenous heparin administration must be selected individually, achieving a stable increase in activated partial thromboplastin time by 2 times compared to its normal value. It is much more convenient to use low molecular weight heparin enoxaparin (Clexane). 30 mg of Clexane is administered intravenously by stream, after which the drug is administered subcutaneously at 1 mg/kg 2 times a day for 3-6 days.

If traditional narcotic analgesics are not available, then 1-2 mg of butorphanol or 50-100 mg of tramadol with 5 mg of droperidol and (or) 2.5 g of analgin with 5 mg of diaepam can be prescribed intravenously slowly or fractionally.

MYOCARDIAL INFARCTION

Diagnostics. Characterized by chest pain (or its equivalents) with irradiation to the left (sometimes to the right) shoulder, forearm, shoulder blade, neck. lower jaw, epigastric region; heart rhythm and conduction disturbances, blood pressure instability: the reaction to nitroglycerin is incomplete or absent. Other variants of the onset of the disease are less commonly observed: asthmatic (cardiac asthma, pulmonary edema). arrhythmic (fainting, sudden death, MAC syndrome). cerebrovascular (acute neurological symptoms), abdominal (pain in the epigastric region, nausea, vomiting), asymptomatic (weakness, vague sensations in the chest). In the anamnesis - risk factors or signs of coronary artery disease, the appearance for the first time or a change in habitual anginal pain. ECG changes (especially in the first hours) may be vague or absent! After 3-10 hours from the onset of the disease - a positive test with troponin-T or I.

Differential diagnosis. In most cases - with prolonged angina, unstable angina, cardialgia. extracardiac pain. TELA, acute illnesses bodies abdominal cavity(pancreatitis, cholecystitis, etc.), dissecting aortic aneurysm.

Urgent Care

1. Shown:

Physical and emotional peace:

Nitroglycerin (tablets or aerosol 0.4-0.5 mg under the tongue repeatedly);

oxygen therapy;

Correction of blood pressure and heart rate;

Acetylsalicylic acid 0.25 g (chew);

Propranolol 20-40 mg orally.

2. For pain relief (depending on the severity of pain, the age of the patient, his condition):

Morphine up to 10 mg or neuroleptanalgesia: fentanyl 0.05-0.1 mg or promedol 10-20 mg with 2.5-5 mg droperidol intravenously fractionally;

With insufficient analgesia - intravenously 2.5 g of analgin, and against the background of high blood pressure - 0.1 mg of clonidine.

3. To restore coronary blood flow:

In case of transmural myocardial infarction with a rise in the 8T segment on the ECG (in the first 6, and with recurrent pain - up to 12 hours from the onset of the disease), inject streptokinase 1,500,000 IU intravenously in 30 minutes as early as possible:

In case of subendocardial myocardial infarction with depression of the 8T segment on the ECG (or the impossibility of thrombolytic therapy), 5000 units of heparin are administered intravenously as soon as possible, and then drip.

4. Continuously monitor heart rate and conduction.

5. Hospitalize after possible stabilization of the condition.

Main dangers and complications:

Acute cardiac arrhythmias and conduction disorders up to sudden death (ventricular fibrillation), especially in the first hours of myocardial infarction;

Recurrence of anginal pain;

Arterial hypotension (including medication);

Acute heart failure (cardiac asthma, pulmonary edema, shock);

arterial hypotension; allergic, arrhythmic, hemorrhagic complications with the introduction of streptokinase;

Respiratory disorders with the introduction of narcotic analgesics;

Myocardial rupture, cardiac tamponade.

Note. For emergency care (in the first hours of the disease or with the development of complications), catheterization of a peripheral vein is indicated.

With recurrent anginal pain or moist rales in the lungs, nitroglycerin should be administered intravenously by drip.

With an increased risk of developing allergic complications, 30 mg of prednisolone should be administered intravenously before the appointment of streptokinase. When conducting thrombolytic therapy, ensure control over the heart rate and basic hemodynamic parameters, readiness to correct possible complications (presence of a defibrillator, a ventilator).

For the treatment of subendocardial (with 8T segment depression and without pathological O wave) myocardial infarction, the rate of intravenous administration of gegyurin must be selected individually, achieving a stable increase in activated partial thromboplastin time by 2 times compared to its normal value. It is much more convenient to use low molecular weight heparin enoxaparin (Clexane). 30 mg of Clexane is administered intravenously by stream, after which the drug is administered subcutaneously at 1 mg/kg 2 times a day for 3-6 days.

If traditional narcotic analgesics are not available, then 1-2 mg of butorphanol or 50-100 mg of tramadol with 5 mg of droperidol and (or) 2.5 g of analgin with 5 mg of diaepam can be prescribed intravenously slowly or fractionally.

CARDIOGENIC PULMONARY EDEMA

Diagnostics. Characteristic: suffocation, shortness of breath, aggravated in the prone position, which forces patients to sit down: tachycardia, acrocyanosis. tissue hyperhydration, inspiratory dyspnea, dry wheezing, then moist rales in the lungs, abundant foamy sputum, ECG changes (hypertrophy or overload of the left atrium and ventricle, blockade of the left leg of the Pua bundle, etc.).

History of myocardial infarction, malformation or other heart disease. hypertension, chronic heart failure.

Differential diagnosis. In most cases, cardiogenic pulmonary edema is differentiated from non-cardiogenic (with pneumonia, pancreatitis, cerebrovascular accident, chemical damage to the lungs, etc.), pulmonary embolism, bronchial asthma.

Urgent Care

1. General activities:

oxygen therapy;

Heparin 5000 IU intravenous bolus:

Correction of heart rate (with a heart rate of more than 150 in 1 min - EIT. with a heart rate of less than 50 in 1 min - EX);

With abundant foam formation - defoaming (inhalation of a 33% solution of ethyl alcohol or intravenously 5 ml of a 96% solution of ethyl alcohol and 15 ml of a 40% glucose solution), in extremely severe (1) cases, 2 ml of a 96% solution of ethyl alcohol is injected into the trachea.

2. With normal blood pressure:

Run step 1;

To seat the patient with lowered lower limbs;

Nitroglycerin tablets (preferably aerosol) 0.4-0.5 mg sublingually again after 3 minutes or up to 10 mg intravenously slowly fractionally or intravenously drip in 100 ml of isotonic sodium chloride solution, increasing the rate of administration from 25 μg / min until effect by controlling blood pressure:

Diazepam up to 10 mg or morphine 3 mg intravenously in divided doses until the effect or a total dose of 10 mg is reached.

3. With arterial hypertension:

Run step 1;

Seating a patient with lowered lower limbs:

Nitroglycerin, tablets (aerosol is better) 0.4-0.5 mg under the tongue once;

Furosemide (Lasix) 40-80 mg IV;

Nitroglycerin intravenously (item 2) or sodium nitroprusside 30 mg in 300 ml of 5% glucose solution intravenously drip, gradually increasing the infusion rate of the drug from 0.3 μg / (kg x min) until the effect is obtained, controlling blood pressure, or pentamine to 50 mg intravenously fractionally or drip:

Intravenously up to 10 mg of diazepam or up to 10 mg of morphine (item 2).

4. With severe arterial hypotension:

Run step 1:

Lay down the patient, raising the head;

Dopamine 200 mg in 400 ml of 5% glucose solution intravenously, increasing the infusion rate from 5 μg / (kg x min) until blood pressure stabilizes at the minimum sufficient level;

If it is impossible to stabilize blood pressure, additionally prescribe norepinephrine hydrotartrate 4 mg in 200 ml of 5-10% glucose solution, increasing the infusion rate from 0.5 mcg / min until blood pressure stabilizes at the minimum sufficient level;

With an increase in blood pressure, accompanied by increasing pulmonary edema, additionally nitroglycerin intravenously drip (p. 2);

Furosemide (Lasix) 40 mg IV after stabilization of blood pressure.

5. Monitor vital functions (heart monitor, pulse oximeter).

6. Hospitalize after possible stabilization of the condition. Main dangers and complications:

Lightning form of pulmonary edema;

Airway obstruction with foam;

respiratory depression;

tachyarrhythmia;

asystole;

Anginal pain:

The increase in pulmonary edema with an increase in blood pressure.

Note. Under the minimum sufficient blood pressure should be understood as a systolic pressure of about 90 mm Hg. Art. provided that an increase in blood pressure is accompanied by clinical signs improve perfusion of organs and tissues.

Eufillin in cardiogenic pulmonary edema is an adjuvant and can be indicated for bronchospasm or severe bradycardia.

Glucocorticoid hormones are used only for respiratory distress syndrome (aspiration, infection, pancreatitis, inhalation of irritants, etc.).

Cardiac glycosides (strophanthin, digoxin) can be prescribed only for moderate congestive heart failure in patients with tachysystolic atrial fibrillation (flutter).

At aortic stenosis, hypertrophic cardiomyopathy, cardiac tamponade, nitroglycerin and other peripheral vaedilators are relatively contraindicated.

It is effective to create positive end-expiratory pressure.

ACE inhibitors (captopril) are useful in preventing recurrence of pulmonary edema in patients with chronic heart failure. At the first appointment of captopril, treatment should begin with a trial dose of 6.25 mg.

CARDIOGENIC SHOCK

Diagnostics. A pronounced decrease in blood pressure in combination with signs of impaired blood supply to organs and tissues. Systolic blood pressure is usually below 90 mm Hg. Art., pulse - below 20 mm Hg. Art. There are symptoms of deterioration of the peripheral circulation (pale cyanotic moist skin, collapsed peripheral veins, a decrease in the temperature of the skin of the hands and feet); decrease in blood flow velocity (the time for the disappearance of a white spot after pressing on the nail bed or palm is more than 2 s), a decrease in diuresis (less than 20 ml / h), impaired consciousness (from mild inhibition to the appearance of focal neurological symptoms and the development of coma).

Differential diagnosis. In most cases, it is necessary to differentiate true cardiogenic shock from its other varieties (reflex, arrhythmic, drug-induced, with slow myocardial rupture, rupture of the septum or papillary muscles, right ventricular damage), as well as from pulmonary embolism, hypovolemia, internal bleeding and arterial hypotension without shock.

Urgent Care

Emergency care must be carried out in stages, quickly moving on to the next stage if the previous one is ineffective.

1. In the absence of pronounced stagnation in the lungs:

Lay the patient down with the lower limbs raised at an angle of 20° (with severe congestion in the lungs - see “Pulmonary edema”):

Carry out oxygen therapy;

With anginal pain, conduct a full anesthesia:

Perform heart rate correction (paroxysmal tachyarrhythmia with a heart rate of more than 150 beats per 1 min - absolute reading to EIT, acute bradycardia with heart rate less than 50 beats per 1 min - to EKS);

Administer heparin 5000 IU intravenously by bolus.

2. In the absence of pronounced stagnation in the lungs and signs of a sharp increase in CVP:

Introduce 200 ml of 0.9% sodium chloride solution intravenously over 10 minutes under the control of blood pressure and respiratory rate. Heart rate, auscultatory picture of the lungs and heart (if possible, control CVP or wedge pressure in the pulmonary artery);

If arterial hypotension persists and there are no signs of transfusion hypervolemia, repeat the introduction of fluid according to the same criteria;

In the absence of signs of transfusion hypervolemia (CVD below 15 cm of water column) infusion therapy continue at a rate of up to 500 ml / h, monitoring the indicated indicators every 15 minutes.

If blood pressure cannot be quickly stabilized, then proceed to the next step.

3. Inject dopamine 200 mg in 400 ml of 5% glucose solution intravenously, increasing the infusion rate starting from 5 µg/(kg x min) until the minimum sufficient arterial pressure is reached;

No effect - additionally prescribe norepinephrine hydrotartrate 4 mg in 200 ml of 5% glucose solution intravenously, increasing the infusion rate from 0.5 μg / min until the minimum sufficient arterial pressure is reached.

4. Monitor vital functions: heart monitor, pulse oximeter.

5. Hospitalize after possible stabilization of the condition.

Main dangers and complications:

Late diagnosis and initiation of treatment:

Failure to stabilize blood pressure:

Pulmonary edema with increased blood pressure or intravenous fluids;

Tachycardia, tachyarrhythmia, ventricular fibrillation;

Asystole:

Recurrence of anginal pain:

Acute renal failure.

Note. Under the minimum sufficient blood pressure should be understood as a systolic pressure of about 90 mm Hg. Art. when signs of improvement in perfusion of organs and tissues appear.

Glucocorpoid hormones are not indicated in true cardiogenic shock.

emergency angina heart attack poisoning

HYPERTENSIVE CRISES

Diagnostics. Increased blood pressure (usually acute and significant) with neurological symptoms: headache, “flies” or a veil before the eyes, paresthesia, a feeling of “crawling”, nausea, vomiting, weakness in the limbs, transient hemiparesis, aphasia, diplopia.

With a neurovegetative crisis (type I crisis, adrenal): sudden onset. excitation, hyperemia and moisture of the skin. tachycardia, frequent and copious urination, a predominant increase in systolic pressure with an increase in pulse.

With a water-salt form of a crisis (crisis type II, noradrenal): gradual onset, drowsiness, adynamia, disorientation, pallor and puffiness of the face, swelling, a predominant increase in diastolic pressure with a decrease in pulse pressure.

With a convulsive form of a crisis: a throbbing, arching headache, psychomotor agitation, repeated vomiting without relief, visual disturbances, loss of consciousness, tonic-clonic convulsions.

Differential diagnosis. First of all, the severity, form and complications of the crisis should be taken into account, crises associated with the sudden withdrawal of antihypertensive drugs (clonidine, β-blockers, etc.) should be distinguished, hypertensive crises should be differentiated from cerebrovascular accidents, diencephalic crises and crises with pheochromocytoma.

Urgent Care

1. Neurovegetative form of crisis.

1.1. For mild flow:

Nifedipine 10 mg sublingually or in drops orally every 30 minutes, or clonidine 0.15 mg sublingually. then 0.075 mg every 30 minutes until the effect, or a combination of these drugs.

1.2. With severe flow.

Clonidine 0.1 mg intravenously slowly (may be combined with 10 mg of nifedipine under the tongue), or sodium nitroprusside 30 mg in 300 ml of 5% glucose solution intravenously, gradually increasing the rate of administration until the required blood pressure is reached, or pentamine up to 50 mg intravenously drip or jet fractionally;

With insufficient effect - furosemide 40 mg intravenously.

1.3. With continued emotional tension, additional diazepam 5-10 mg orally, intramuscularly or intravenously, or droperidol 2.5-5 mg intravenously slowly.

1.4. With persistent tachycardia, propranolol 20-40 mg orally.

2. Water-salt form of crisis.

2.1. For mild flow:

Furosemide 40–80 mg orally once and nifedipine 10 mg sublingually or in drops orally every 30 minutes until effect, or furosemide 20 mg orally once and captopril 25 mg sublingually or orally every 30–60 minutes until effect.

2.2. With severe flow.

Furosemide 20-40 mg intravenously;

Sodium nitroprusside or pentamine intravenously (section 1.2).

2.3. With persistent neurological symptoms, it can be effective intravenous administration 240 mg aminophylline.

3. Convulsive form of crisis:

Diazepam 10-20 mg intravenously slowly until seizures are eliminated, magnesium sulfate 2.5 g intravenously very slowly can be administered additionally:

Sodium nitroprusside (section 1.2) or pentamine (section 1.2);

Furosemide 40-80 mg intravenously slowly.

4. Crises associated with the sudden withdrawal of antihypertensive drugs:

Appropriate antihypertensive drug intravenously. under the tongue or inside, with pronounced arterial hypertension - sodium nitroprusside (section 1.2).

5. Hypertensive crisis complicated by pulmonary edema:

Nitroglycerin (preferably an aerosol) 0.4-0.5 mg under the tongue and immediately 10 mg in 100 ml of isotonic sodium chloride solution intravenously. by increasing the rate of infusion from 25 µg/min until effect is obtained, either sodium nitroprusside (section 1.2) or pentamine (section 1.2);

Furosemide 40-80 mg intravenously slowly;

Oxygen therapy.

6. Hypertensive crisis complicated by hemorrhagic stroke or subarachnoid hemorrhage:

With pronounced arterial hypertension - sodium nitroprusside (section 1.2). reduce blood pressure to values ​​​​exceeding the usual values ​​​​for this patient, with an increase in neurological symptoms, reduce the rate of administration.

7. Hypertensive crisis complicated by anginal pain:

Nitroglycerin (preferably an aerosol) 0.4-0.5 mg under the tongue and immediately 10 mg intravenously drip (item 5);

Required anesthesia - see "Angina":

With insufficient effect - propranolol 20-40 mg orally.

8. With a complicated course- monitor vital functions (heart monitor, pulse oximeter).

9. Hospitalize after possible stabilization of the condition .

Main dangers and complications:

arterial hypotension;

Violation of cerebral circulation (hemorrhagic or ischemic stroke);

Pulmonary edema;

Anginal pain, myocardial infarction;

Tachycardia.

Note. In acute arterial hypertension, immediately shortening life, reduce blood pressure within 20-30 minutes to the usual, “working” or slightly higher values, use intravenous. the route of administration of drugs, the hypotensive effect of which can be controlled (sodium nitroprusside, nitroglycerin.).

In a hypertensive crisis without an immediate threat to life, lower blood pressure gradually (for 1-2 hours).

When the course of hypertension worsens, not reaching a crisis, blood pressure must be reduced within a few hours, the main antihypertensive drugs should be administered orally.

In all cases, blood pressure should be reduced to the usual, "working" values.

To provide emergency care for repeated hypertensive crises of SLS diets, taking into account the existing experience in the treatment of previous ones.

When using captopril for the first time, treatment should begin with a trial dose of 6.25 mg.

The hypotensive effect of pentamine is difficult to control, so the drug can only be used in cases where an emergency lowering of blood pressure is indicated and there are no other options for this. Pentamine is administered in doses of 12.5 mg intravenously in fractions or drops up to 50 mg.

In a crisis in patients with pheochromocytoma, raise the head of the bed to. 45°; prescribe (rentolation (5 mg intravenously 5 minutes before the effect.); you can use prazosin 1 mg sublingually repeatedly or sodium nitroprusside. As an auxiliary drug, droperidol 2.5-5 mg intravenously slowly. Blockers of P-adrenoreceptors should be changed only (!) after the introduction of a-adreneroreceptor blockers.

PULMONARY EMBOLISM

Diagnostics Massive PE manifests itself sudden stop blood circulation by electromechanical dissociation), or shock with severe shortness of breath, tachycardia, pallor or sharp cyanosis of the skin of the upper half of the body, swelling of the jugular veins, antinose-like pain, electrocardiographic manifestations of acute cor pulmonale.

Non-gossive PE is manifested by shortness of breath, tachycardia, arterial hypotension. signs of pulmonary infarction (pulmonary-pleural pain, cough, in some patients - with sputum stained with blood, fever, crepitant wheezing in the lungs).

For the diagnosis of PE, it is important to take into account the presence of risk factors for the development of thromboembolism, such as a history of thromboembolic complications, advanced age, prolonged immobilization, recent surgical intervention, heart disease, heart failure, atrial fibrillation, oncological diseases, TGV.

Differential diagnosis. In most cases - with myocardial infarction, acute heart failure (cardiac asthma, pulmonary edema, cardiogenic shock), bronchial asthma, pneumonia, spontaneous pneumothorax.

Urgent Care

1. With the cessation of blood circulation - CPR.

2. With massive PE with arterial hypotension:

Oxygen therapy:

Catheterization of the central or peripheral vein:

Heparin 10,000 IU intravenously by stream, then drip at an initial rate of 1000 IU / h:

Infusion therapy (reopoliglyukin, 5% glucose solution, hemodez, etc.).

3. In case of severe arterial hypotension, not corrected by infusion therapy:

Dopamine, or adrenaline intravenously drip. increasing the rate of administration until blood pressure stabilizes;

Streptokinase (250,000 IU intravenously drip for 30 minutes, then intravenously drip at a rate of 100,000 IU/h to a total dose of 1,500,000 IU).

4. With stable blood pressure:

oxygen therapy;

Catheterization of a peripheral vein;

Heparin 10,000 IU intravenously by stream, then drip at a rate of 1000 IU / h or subcutaneously at 5000 IU after 8 hours:

Eufillin 240 mg intravenously.

5. In case of recurrent PE, additionally prescribe 0.25 g of acetylsalicylic acid orally.

6. Monitor vital functions (heart monitor, pulse oximeter).

7. Hospitalize after possible stabilization of the condition.

Main dangers and complications:

Electromechanical dissociation:

Inability to stabilize blood pressure;

Increasing respiratory failure:

PE recurrence.

Note. With a aggravated allergic history, 30 mg of predniolone is administered intravenously by stream before the appointment of strepyayukinoz.

For the treatment of PE, the rate of intravenous heparin administration must be selected individually, achieving a stable increase in activated partial thromboplastin time by 2 times compared to its normal value.

STROKE (ACUTE CEREBRAL CIRCULATION DISTURBANCE)

Stroke (stroke) is a rapidly developing focal or global impairment of brain function, lasting more than 24 hours or leading to death if another genesis of the disease is excluded. It develops against the background of atherosclerosis of cerebral vessels, hypertension, their combination or as a result of rupture of cerebral aneurysms.

Diagnostics The clinical picture depends on the nature of the process (ischemia or hemorrhage), localization (hemispheres, trunk, cerebellum), the rate of development of the process (sudden, gradual). Stroke of any genesis is characterized by the presence of focal symptoms brain lesions (hemiparesis or hemiplegia, less often monoparesis and lesions cranial nerves- facial, sublingual, oculomotor) and cerebral symptoms varying degrees severity (headache, dizziness, nausea, vomiting, impaired consciousness).

CVA is clinically manifested by subarachnoid or intracerebral hemorrhage (hemorrhagic stroke), or ischemic stroke.

Transient cerebrovascular accident (TIMC) is a condition in which focal symptoms undergo complete regression over a period of less than 24 hours. The diagnosis is made retrospectively.

Suborocnoid hemorrhages develop as a result of rupture of aneurysms and less often against the background of hypertension. Characterized by the sudden onset of a sharp headache, followed by nausea, vomiting, motor excitation, tachycardia, sweating. With massive subarachnoid hemorrhage, as a rule, depression of consciousness is observed. Focal symptoms are often absent.

Hemorrhagic stroke - bleeding into the substance of the brain; characterized by a sharp headache, vomiting, rapid (or sudden) depression of consciousness, accompanied by the appearance of pronounced symptoms of dysfunction of the limbs or bulbar disorders (peripheral paralysis of the muscles of the tongue, lips, soft palate, pharynx, vocal folds and epiglottis due to damage to the IX, X and XII pairs of cranial nerves or their nuclei located in the medulla oblongata). It usually develops during the day, during wakefulness.

Ischemic stroke is a disease that leads to a decrease or cessation of blood supply to a certain part of the brain. It is characterized by a gradual (over hours or minutes) increase in focal symptoms corresponding to the affected vascular pool. Cerebral symptoms are usually less pronounced. Develops more often with normal or low blood pressure, often during sleep

At the prehospital stage, it is not required to differentiate the nature of the stroke (ischemic or hemorrhagic, subarachnoid hemorrhage and its localization.

Differential diagnosis should be carried out with a traumatic brain injury (history, the presence of traces of trauma on the head) and much less often with meningoencephalitis (history, signs of a general infectious process, rash).

Urgent Care

Basic (undifferentiated) therapy includes emergency correction of vital functions - restoration of patency of the upper respiratory tract, if necessary - tracheal intubation, artificial ventilation of the lungs, as well as normalization of hemodynamics and cardiac activity:

With arterial pressure significantly higher than usual values ​​- its decrease to indicators slightly higher than the “working” one, which is familiar to this patient, if there is no information, then to the level of 180/90 mm Hg. Art.; for this use - 0.5-1 ml of a 0.01% solution of clonidine (clophelin) in 10 ml of a 0.9% solution of sodium chloride intravenously or intramuscularly or 1-2 tablets sublingually (if necessary, the administration of the drug can be repeated), or pentamine - no more than 0, 5 ml of a 5% solution intravenously at the same dilution or 0.5-1 ml intramuscularly:

As an additional remedy, you can use Dibazol 5-8 ml of a 1% solution intravenously or nifedipine (Corinfar, fenigidin) - 1 tablet (10 mg) sublingually;

For cupping seizures, psychomotor agitation - diazepam (Relanium, Seduxen, Sibazon) 2-4 ml intravenously with 10 ml of 0.9% sodium chloride solution slowly or intramuscularly or Rohypnol 1-2 ml intramuscularly;

With inefficiency - 20% solution of sodium hydroxybutyrate at the rate of 70 mg / kg of body weight in 5-10% glucose solution intravenously slowly;

In case of repeated vomiting - cerucal (raglan) 2 ml intravenously in a 0.9% solution intravenously or intramuscularly:

Vitamin Wb 2 ml of 5% solution intravenously;

Droperidol 1-3 ml of 0.025% solution, taking into account the patient's body weight;

With a headache - 2 ml of a 50% solution of analgin or 5 ml of baralgin intravenously or intramuscularly;

Tramal - 2 ml.

Tactics

For patients of working age in the first hours of the disease, it is mandatory to call a specialized neurological (neuroresuscitation) team. Shown hospitalization on a stretcher in the neurological (neurovascular) department.

In case of refusal of hospitalization - a call to the neurologist of the polyclinic and, if necessary, an active visit to the emergency doctor after 3-4 hours.

Non-transportable patients in deep atonic coma (5-4 points on the Glasgow scale) with intractable severe respiratory disorders: unstable hemodynamics, with a rapid, steady deterioration.

Dangers and Complications

Obstruction of the upper respiratory tract by vomit;

Aspiration of vomit;

Inability to normalize blood pressure:

swelling of the brain;

Breakthrough of blood into the ventricles of the brain.

Note

1. Early use of antihypoxants and activators of cellular metabolism is possible (nootropil 60 ml (12 g) intravenously bolus 2 times a day after 12 hours on the first day; cerebrolysin 15-50 ml intravenously by drip per 100-300 ml of isotonic solution in 2 doses; glycine 1 tablet under the tongue riboyusin 10 ml intravenously bolus, solcoseryl 4 ml intravenous bolus, in severe cases 250 ml 10% solution of solcoseryl intravenously drip can significantly reduce the number of irreversibly damaged cells in the ischemic zone, reduce the area of ​​perifocal edema.

2. Aminazine and propazine should be excluded from the funds prescribed for any form of stroke. These drugs sharply inhibit the functions of the brain stem structures and clearly worsen the condition of patients, especially the elderly and senile.

3. Magnesium sulfate is not used for convulsions and to lower blood pressure.

4. Eufillin is shown only in the first hours of an easy stroke.

5. Furosemide (Lasix) and other dehydrating agents (mannitol, rheogluman, glycerol) should not be administered in the prehospital setting. The need to prescribe dehydrating agents can only be determined in a hospital based on the results of determining plasma osmolality and sodium content in blood serum.

6. In the absence of a specialized neurological team, hospitalization in the neurological department is indicated.

7. For patients of any age with the first or repeated stroke with minor defects after previous episodes, a specialized neurological (neuroresuscitation) team can also be called on the first day of the disease.

BRONCHOASTMATIC STATUS

Bronchoasthmatic status is one of the most severe variants of the course of bronchial asthma, manifested by acute obstruction. bronchial tree as a result of bronchiolospasm, hyperergic inflammation and edema of the mucous membrane, hypersecretion of the glandular apparatus. The formation of the status is based on a deep blockade of p-adrenergic receptors of the smooth muscles of the bronchi.

Diagnostics

An attack of suffocation with difficulty exhaling, increasing dyspnea at rest, acrocyanosis, increased sweating, hard breathing with dry scattered wheezing and the subsequent formation of areas of a “silent” lung, tachycardia, high blood pressure, participation in breathing of auxiliary muscles, hypoxic and hypercapnic coma. When conducting drug therapy, resistance to sympathomimetics and other bronchodilators is revealed.

Urgent Care

Asthmatic status is a contraindication to the use of β-agonists (agonists) due to loss of sensitivity (lung receptors to these drugs. However, this loss of sensitivity can be overcome with the help of nebulizer technique.

Drug therapy is based on the use of selective p2-agonists fenoterol (berotec) at a dose of 0.5-1.5 mg or salbutamol at a dose of 2.5-5.0 mg or a complex preparation of berodual containing fenoterol and the anticholinergic drug ypra using nebulizer technology. -tropium bromide (atrovent). The dosage of berodual is 1-4 ml per inhalation.

In the absence of a nebulizer, these drugs are not used.

Eufillin is used in the absence of a nebulizer or in especially severe cases with the ineffectiveness of nebulizer therapy.

The initial dose is 5.6 mg / kg of body weight (10-15 ml of a 2.4% solution intravenously slowly, over 5-7 minutes);

Maintenance dose - 2-3.5 ml of a 2.4% solution fractionally or drip until improvement clinical condition patient.

Glucocorticoid hormones - in terms of methylprednisolone 120-180 mg intravenously by stream.

Oxygen therapy. Continuous insufflation (mask, nasal catheters) of an oxygen-air mixture with an oxygen content of 40-50%.

Heparin - 5,000-10,000 IU intravenously with one of the plasma-substituting solutions; it is possible to use low molecular weight heparins (fraxiparin, clexane, etc.)

Contraindicated

Sedatives and antihistamines (inhibit the cough reflex, increase bronchopulmonary obstruction);

Mucolytic mucus thinners:

antibiotics, sulfonamides, novocaine (have a high sensitizing activity);

Calcium preparations (deepen initial hypokalemia);

Diuretics (increase initial dehydration and hemoconcentration).

In a coma

Urgent tracheal intubation for spontaneous breathing:

Artificial ventilation of the lungs;

If necessary - cardiopulmonary resuscitation;

Medical therapy (see above)

Indications for tracheal intubation and mechanical ventilation:

hypoxic and hyperkalemic coma:

Cardiovascular collapse:

The number of respiratory movements is more than 50 in 1 min. Transportation to the hospital against the background of ongoing therapy.

SEVERAL SYNDROME

Diagnostics

A generalized generalized convulsive seizure is characterized by the presence of tonic-clonic convulsions in the limbs, accompanied by loss of consciousness, foam at the mouth, often - biting of the tongue, involuntary urination, and sometimes defecation. At the end of the seizure, there is a pronounced respiratory arrhythmia. Long periods of apnea are possible. At the end of the seizure, the patient is in a deep coma, the pupils are maximally dilated, without reaction to light, the skin is cyanotic, often moist.

Simple partial seizures without loss of consciousness are manifested by clonic or tonic convulsions in certain muscle groups.

Complex partial seizures (temporal lobe epilepsy or psychomotor seizures) are episodic behavioral changes when the patient loses contact with the outside world. The beginning of such seizures may be the aura (olfactory, gustatory, visual, sensation of “already seen”, micro or macropsia). During complex attacks, inhibition of motor activity may be observed; or smacking tubas, swallowing, walking aimlessly, picking off one's own clothes (automatisms). At the end of the attack, amnesia is noted for the events that took place during the attack.

The equivalents of convulsive seizures are manifested in the form of gross disorientation, somnambulism and a prolonged twilight state, during which unconscious, most severe antisocial acts can be performed.

Status epilepticus - a fixed epileptic state due to a prolonged epileptic seizure or a series of seizures that recur at short intervals. Status epilepticus and recurrent seizures are life-threatening conditions.

Seizures can be a manifestation of genuine ("congenital") and symptomatic epilepsy - a consequence of past diseases (brain injury, cerebrovascular accident, neuro-infection, tumor, tuberculosis, syphilis, toxoplasmosis, cysticercosis, Morgagni-Adams-Stokes syndrome, ventricular fibrillation , eclampsia) and intoxication.

Differential Diagnosis

At the prehospital stage, determining the cause of a seizure is often extremely difficult. The anamnesis and clinical data are of great importance. Special care must be taken with respect to first of all, traumatic brain injury, acute cerebrovascular accidents, cardiac arrhythmias, eclampsia, tetanus and exogenous intoxications.

Urgent Care

1. After a single convulsive seizure - diazepam (Relanium, Seduxen, Sibazon) - 2 ml intramuscularly (as a prevention of recurrent seizures).

2. With a series of convulsive seizures:

Head and torso injury prevention:

Relief of convulsive syndrome: diazepam (Relanium, Seduxen, Sibazon) - 2-4 ml per 10 ml of 0.9% sodium chloride solution intravenously or intramuscularly, Rohypnol 1-2 ml intramuscularly;

In the absence of effect - sodium hydroxybutyrate 20% solution at the rate of 70 mg / kg of body weight intravenously in 5-10% glucose solution;

Decongestant therapy: furosemide (lasix) 40 mg per 10-20 ml of 40% glucose or 0.9% sodium chloride solution (in patients diabetes)

intravenously;

Headache relief: analgin 2 ml 50% solution: baralgin 5 ml; tramal 2 ml intravenously or intramuscularly.

3. Status epilepticus

Prevention of trauma to the head and torso;

Restoration of airway patency;

Relief of convulsive syndrome: diazepam (Relanium, Seduxen, Syabazone) _ 2-4 ml per 10 ml of 0.9% sodium chloride solution intravenously or intramuscularly, Rohypnol 1-2 ml intramuscularly;

In the absence of effect - sodium hydroxybutyrate 20% solution at the rate of 70 mg / kg of body weight intravenously in 5-10% glucose solution;

In the absence of effect - inhalation anesthesia with nitrous oxide mixed with oxygen (2:1).

Decongestant therapy: furosemide (lasix) 40 mg per 10-20 ml of 40% glucose or 0.9% sodium chloride solution (in diabetic patients) intravenously:

Relief of headache:

Analgin - 2 ml of 50% solution;

- baralgin - 5 ml;

Tramal - 2 ml intravenously or intramuscularly.

According to indications:

With an increase in blood pressure significantly higher than the patient's usual indicators - antihypertensive drugs (clofelin intravenously, intramuscularly or sublingual tablets, dibazol intravenously or intramuscularly);

With tachycardia over 100 beats / min - see "Tachyarrhythmias":

With bradycardia less than 60 beats / min - atropine;

With hyperthermia over 38 ° C - analgin.

Tactics

Patients with the first convulsive seizure in their lives should be hospitalized to find out its cause. In case of refusal of hospitalization with a rapid recovery of consciousness and the absence of cerebral and focal neurological symptoms, an urgent appeal to a neurologist at a polyclinic at the place of residence is recommended. If consciousness is restored slowly, there are cerebral and (or) focal symptoms, then a call for a specialized neurological (neuro-resuscitation) team is indicated, and in its absence, an active visit after 2-5 hours.

Intractable status epilepticus or a series of convulsive seizures is an indication for calling a specialized neurological (neuroresuscitation) team. In the absence of such - hospitalization.

In case of violation of the activity of the heart, which led to a convulsive syndrome, appropriate therapy or a call to a specialized cardiological team. With eclampsia, exogenous intoxication - action according to the relevant recommendations.

Main dangers and complications

Asphyxia during a seizure:

Development of acute heart failure.

Note

1. Aminazine is not an anticonvulsant.

2. Magnesium sulfate and chloral hydrate are not currently available.

3. The use of hexenal or sodium thiopental for the relief of status epilepticus is possible only in the conditions of a specialized team, if there are conditions and the ability to transfer the patient to mechanical ventilation if necessary. (laryngoscope, set of endotracheal tubes, ventilator).

4. With glucalcemic convulsions, calcium gluconate is administered (10-20 ml of a 10% solution intravenously or intramuscularly), calcium chloride (10-20 ml of a 10% solution strictly intravenously).

5. With hypokalemic convulsions, Panangin is administered (10 ml intravenously).

FAINTING (SHORT-TERM LOSS OF CONSCIOUSNESS, SYNCOPE)

Diagnostics

Fainting. - short-term (usually within 10-30 s) loss of consciousness. in most cases accompanied by a decrease in postural vascular tone. Syncope is based on transient hypoxia of the brain, which occurs due to various reasons - a decrease in cardiac output. heart rhythm disturbances, reflex decrease in vascular tone, etc.

Fainting (syncope) conditions can be conditionally divided into two most common forms - vasodepressor (synonyms - vasovagal, neurogenic) syncope, which are based on a reflex decrease in postural vascular tone, and syncope associated with diseases of the heart and great vessels.

Syncopal states have different prognostic significance depending on their genesis. Fainting associated with the pathology of the cardiovascular system can be harbingers of sudden death and require mandatory identification of their causes and adequate treatment. It must be remembered that fainting may be the debut of a severe pathology (myocardial infarction, pulmonary embolism, etc.).

The most common clinical form is vasodepressor syncope, in which there is a reflex decrease in peripheral vascular tone in response to external or psychogenic factors (fear, excitement, type of blood, medical instruments, vein puncture. heat environment, being in a stuffy room, etc.). The development of fainting is preceded by a short prodromal period, during which weakness, nausea, ringing in the ears, yawning, darkening of the eyes, pallor, cold sweat are noted.

If the loss of consciousness is short-term, convulsions are not noted. If fainting lasts more than 15-20 s. clonic and tonic convulsions are noted. During syncope, there is a decrease in blood pressure with bradycardia; or without it. This group also includes fainting that occurs with increased sensitivity of the carotid sinus, as well as the so-called "situational" fainting - with prolonged coughing, defecation, urination. Syncope associated with pathology of cardio-vascular system usually occur suddenly, without a prodromal period. They are divided into two main groups - associated with cardiac arrhythmias and conduction disorders and caused by a decrease in cardiac output (aortic stenosis, hypertrophic cardiomyopathy, myxoma and spherical blood clots in the atria, myocardial infarction, pulmonary embolism, dissecting aortic aneurysm).

Differential Diagnosis syncope should be carried out with epilepsy, hypoglycemia, narcolepsy, coma of various origins, diseases of the vestibular apparatus, organic pathology of the brain, hysteria.

In most cases, the diagnosis can be made based on a detailed history, physical examination, and ECG recording. To confirm the vasodepressor nature of syncope, positional tests are performed (from simple orthostatic tests to the use of a special inclined table), to increase sensitivity, the tests are performed against the background of drug therapy. If these actions do not clarify the cause of fainting, then a subsequent examination in the hospital is carried out depending on the identified pathology.

In the presence of heart disease: ECG Holter monitoring, echocardiography, electrophysiological examination, positional tests: if necessary, cardiac catheterization.

In the absence of heart disease: positional tests, consultation with a neurologist, psychiatrist, Holter ECG monitoring, electroencephalogram, if necessary - CT scan brain, angiography.

Urgent Care

When fainting is usually not required.

The patient must be placed in horizontal position on the back:

give lower limbs elevated position, free from tight clothing neck and chest:

Patients should not be seated immediately, as this may lead to a relapse of fainting;

If the patient does not regain consciousness, it is necessary to exclude a traumatic brain injury (if there was a fall) or other causes of prolonged loss of consciousness indicated above.

If syncope is caused by cardiac disease, emergency care may be needed to address the immediate cause of syncope - tachyarrhythmia, bradycardia, hypotension, etc. (see relevant sections).

ACUTE POISONING

Poisoning - pathological conditions caused by the action of toxic substances of exogenous origin in any way they enter the body.

The severity of the condition in case of poisoning is determined by the dose of the poison, the route of its intake, the time of exposure, the patient's premorbid background, complications (hypoxia, bleeding, convulsive syndrome, acute cardiovascular failure, etc.).

The prehospital doctor needs:

Observe “toxicological alertness” (environmental conditions in which the poisoning occurred, the presence of foreign odors may pose a danger to the ambulance team):

Find out the circumstances that accompanied the poisoning (when, with what, how, how much, for what purpose) in the patient himself, if he is conscious or in those around him;

Collect material evidence (drug packages, powders, syringes), biological media (vomit, urine, blood, wash water) for chemical-toxicological or forensic chemical research;

Register the main symptoms (syndromes) that the patient had before the provision of medical care, including mediator syndromes, which are the result of strengthening or inhibition of the sympathetic and parasympathetic systems (see Appendix).

GENERAL ALGORITHM FOR PROVIDING EMERGENCY AID

1. Ensure normalization of respiration and hemodynamics (perform basic cardiopulmonary resuscitation).

2. Carry out antidote therapy.

3. Stop further intake of poison into the body. 3.1. In case of inhalation poisoning - remove the victim from the contaminated atmosphere.

3.2. In case of oral poisoning - rinse the stomach, introduce enterosorbents, put a cleansing enema. When washing the stomach or washing off poisons from the skin, use water with a temperature not exceeding 18 ° C; do not carry out the poison neutralization reaction in the stomach! The presence of blood during gastric lavage is not a contraindication for gastric lavage.

3.3. For skin application - wash the affected area of ​​the skin with an antidote solution or water.

4. Start infusion and symptomatic therapy.

5. Transport the patient to the hospital. This algorithm for providing assistance at the prehospital stage is applicable to all types of acute poisoning.

Diagnostics

With mild and moderate severity, an anticholinergic syndrome occurs (intoxication psychosis, tachycardia, normohypotension, mydriasis). In severe coma, hypotension, tachycardia, mydriasis.

Antipsychotics cause the development of orthostatic collapse, prolonged persistent hypotension due to insensitivity of the terminal vascular bed to vasopressors, extrapyramidal syndrome (muscle cramps of the chest, neck, upper shoulder girdle, protrusion of the tongue, bulging eyes), neuroleptic syndrome (hyperthermia, muscle rigidity).

Hospitalization of the patient in a horizontal position. Cholinolytics cause the development of retrograde amnesia.

Opiate poisoning

Diagnostics

Characteristic: oppression of consciousness, to a deep coma. development of apnea, tendencies to bradycardia, injection marks on the elbows.

emergency therapy

Pharmacological antidotes: naloxone (narcanti) 2-4 ml of a 0.5% solution intravenously until spontaneous respiration is restored: if necessary, repeat the administration until mydriasis appears.

Start infusion therapy:

400.0 ml of 5-10% glucose solution intravenously;

Reopoliglyukin 400.0 ml intravenous drip.

Sodium bicarbonate 300.0 ml 4% intravenously;

oxygen inhalation;

In the absence of the effect of the introduction of naloxone, carry out mechanical ventilation in the hyperventilation mode.

Tranquilizer poisoning (benzodiazepine group)

Diagnostics

Characteristic: drowsiness, ataxia, depression of consciousness to coma 1, miosis (in case of poisoning with noxiron - mydriasis) and moderate hypotension.

Tranquilizers of the benzodiazepine series cause deep depression of consciousness only in “mixed” poisonings, i.e. in combination with barbiturates. neuroleptics and other sedative-hypnotic drugs.

emergency therapy

Follow steps 1-4 of the general algorithm.

For hypotension: reopoliglyukin 400.0 ml intravenously, drip:

Barbiturate poisoning

Diagnostics

Miosis, hypersalivation, "greasiness" of the skin, hypotension, deep depression of consciousness up to the development of coma are determined. Barbiturates cause a rapid breakdown of tissue trophism, the formation of bedsores, the development of positional compression syndrome, and pneumonia.

Urgent Care

Pharmacological antidotes (see note).

Run point 3 of the general algorithm;

Start infusion therapy:

Sodium bicarbonate 4% 300.0, intravenous drip:

Glucose 5-10% 400.0 ml intravenously;

Sulfocamphocaine 2.0 ml intravenously.

oxygen inhalation.

POISONING WITH DRUGS OF STIMULANT ACTION

These include antidepressants, psychostimulants, general tonic (tinctures, including alcohol ginseng, eleutherococcus).

Delirium, hypertension, tachycardia, mydriasis, convulsions, cardiac arrhythmias, ischemia and myocardial infarction are determined. They have an oppression of consciousness, hemodynamics and respiration after the phase of excitation and hypertension.

Poisoning occurs with adrenergic (see Appendix) syndrome.

Poisoning with antidepressants

Diagnostics

With a short duration of action (up to 4-6 hours), hypertension is determined. delirium. dryness of the skin and mucous membranes, expansion of the 9K8 complex on the ECG (quinidine-like effect of tricyclic antidepressants), convulsive syndrome.

With prolonged action (more than 24 hours) - hypotension. urinary retention, coma. Always mydriasis. dryness of the skin, expansion of the OK8 complex on the ECG: Antidepressants. serotonin blockers: fluoxentine (Prozac), fluvoxamine (paroxetine), alone or in combination with analgesics, can cause “malignant” hyperthermia.

Urgent Care

Follow point 1 of the general algorithm. For hypertension and agitation:

Short-acting drugs with a rapidly onset effect: galantamine hydrobromide (or nivalin) 0.5% - 4.0-8.0 ml, intravenously;

Long-acting drugs: aminostigmine 0.1% - 1.0-2.0 ml intramuscularly;

In the absence of antagonists, anticonvulsants: Relanium (Seduxen), 20 mg per 20.0 ml of 40% glucose solution intravenously; or sodium oxybutyrate 2.0 g per - 20.0 ml of 40.0% glucose solution intravenously, slowly);

Follow point 3 of the general algorithm. Start infusion therapy:

In the absence of sodium bicarbonate - trisol (disol. Chlosol) 500.0 ml intravenously, drip.

With severe arterial hypotension:

Reopoliglyukin 400.0 ml intravenously, drip;

Norepinephrine 0.2% 1.0 ml (2.0) in 400 ml of 5-10% glucose solution intravenously, drip, increase the rate of administration until blood pressure stabilizes.

POISONING WITH ANTI-TUBERCULOSIS DRUGS (ISONIAZIDE, FTIVAZIDE, TUBAZIDE)

Diagnostics

Characteristic: generalized convulsive syndrome, development of stunning. up to coma, metabolic acidosis. Any convulsive syndrome resistant to benzodiazepine treatment should alert for isoniazid poisoning.

Urgent Care

Run point 1 of the general algorithm;

With convulsive syndrome: pyridoxine up to 10 ampoules (5 g). intravenous drip for 400 ml of 0.9% sodium chloride solution; Relanium 2.0 ml, intravenously. before relief of the convulsive syndrome.

If there is no result, muscle relaxants of antidepolarizing action (arduan 4 mg), tracheal intubation, mechanical ventilation.

Follow point 3 of the general algorithm.

Start infusion therapy:

Sodium bicarbonate 4% 300.0 ml intravenously, drip;

Glucose 5-10% 400.0 ml intravenously, drip. With arterial hypotension: reopoliglyukin 400.0 ml intravenously. drip.

Early detoxification hemosorption is effective.

POISONING WITH TOXIC ALCOHOL (METHANOL, ETHYLENE GLYCOL, CELLOSOLVES)

Diagnostics

Characteristic: the effect of intoxication, decreased visual acuity (methanol), abdominal pain (propyl alcohol; ethylene glycol, cellosolva with prolonged exposure), depression of consciousness to deep coma, decompensated metabolic acidosis.

Urgent Care

Run point 1 of the general algorithm:

Run point 3 of the general algorithm:

Ethanol is the pharmacological antidote for methanol, ethylene glycol, and cellosolves.

Initial therapy with ethanol (saturation dose per 80 kg of the patient's body weight, at the rate of 1 ml of a 96% alcohol solution per 1 kg of body weight). To do this, dilute 80 ml of 96% alcohol with water in half, give a drink (or enter through a probe). If it is impossible to prescribe alcohol, 20 ml of a 96% alcohol solution is dissolved in 400 ml of a 5% glucose solution and the resulting alcohol solution of glucose is injected into a vein at a rate of 100 drops / min (or 5 ml of solution per minute).

Start infusion therapy:

Sodium bicarbonate 4% 300 (400) intravenously, drip;

Acesol 400 ml intravenously, drip:

Hemodez 400 ml intravenously, drip.

When transferring a patient to a hospital, indicate the dose, time and route of administration of the ethanol solution at the prehospital stage to provide a maintenance dose of ethanol (100 mg/kg/hour).

ETHANOL POISONING

Diagnostics

Determined: depression of consciousness to deep coma, hypotension, hypoglycemia, hypothermia, cardiac arrhythmias, respiratory depression. Hypoglycemia, hypothermia lead to the development of cardiac arrhythmias. In alcoholic coma, the lack of response to naloxone may be due to concomitant traumatic brain injury (subdural hematoma).

Urgent Care

Follow steps 1-3 of the general algorithm:

With depression of consciousness: naloxone 2 ml + glucose 40% 20-40 ml + thiamine 2.0 ml intravenously slowly. Start infusion therapy:

Sodium bicarbonate 4% 300-400 ml intravenously;

Hemodez 400 ml intravenous drip;

Sodium thiosulfate 20% 10-20 ml intravenously slowly;

Unithiol 5% 10 ml intravenously slowly;

Ascorbic acid 5 ml intravenously;

Glucose 40% 20.0 ml intravenously.

When excited: Relanium 2.0 ml intravenously slowly in 20 ml of 40% glucose solution.

Withdrawal state caused by alcohol consumption

When examining a patient at the prehospital stage, it is advisable to adhere to certain sequences and principles of emergency care for acute alcohol poisoning.

Establish the fact of recent alcohol intake and determine its characteristics (date of last intake, binge or single intake, quantity and quality of alcohol consumed, total duration of regular alcohol intake). Adjustment for the social status of the patient is possible.

· Establish the fact of chronic alcohol intoxication, the level of nutrition.

Determine the risk of developing a withdrawal syndrome.

· As part of toxic visceropathy, to determine: the state of consciousness and mental functions, to identify gross neurological disorders; the stage of alcoholic liver disease, the degree of liver failure; identify damage to other target organs and the degree of their functional usefulness.

Determine the prognosis of the condition and develop a plan for monitoring and pharmacotherapy.

It is obvious that the clarification of the patient's "alcohol" history is aimed at determining the severity of the current acute alcohol poisoning, as well as the risk of developing alcohol withdrawal syndrome (3-5 days after the last alcohol intake).

In the treatment of acute alcohol intoxication, a set of measures is needed aimed, on the one hand, at stopping the further absorption of alcohol and its accelerated removal from the body, and on the other hand, at protecting and maintaining systems or functions that suffer from the effects of alcohol.

The intensity of therapy is determined both by the severity of acute alcohol intoxication and the general condition of the intoxicated person. In this case, gastric lavage is carried out in order to remove alcohol that has not yet been absorbed, and drug therapy with detoxification agents and alcohol antagonists.

In the treatment of alcohol withdrawal the doctor takes into account the severity of the main components of the withdrawal syndrome (somato-vegetative, neurological and mental disorders). Mandatory components are vitamin and detoxification therapy.

Vitamin therapy includes parenteral administration of solutions of thiamine (Vit B1) or pyridoxine hydrochloride (Vit B6) - 5-10 ml. With severe tremor, a solution of cyanocobalamin (Vit B12) is prescribed - 2-4 ml. The simultaneous administration of various B vitamins is not recommended due to the possibility of amplification allergic reactions and their incompatibility in one syringe. Ascorbic acid (Vit C) - up to 5 ml is administered intravenously along with plasma-substituting solutions.

Detoxification therapy includes the introduction of thiol preparations - a 5% solution of unithiol (1 ml per 10 kg of body weight intramuscularly) or a 30% solution of sodium thiosulfate (up to 20 ml); hypertonic - 40% glucose - up to 20 ml, 25% magnesium sulfate (up to 20 ml), 10% calcium chloride (up to 10 ml), isotonic - 5% glucose (400-800 ml), 0.9% sodium chloride solution ( 400-800 ml) and plasma-substituting - Hemodez (200-400 ml) solutions. It is also advisable, intravenous administration of a 20% solution of piracetam (up to 40 ml).

These measures, according to indications, are supplemented by the relief of somato-vegetative, neurological and mental disorders.

With an increase in blood pressure, 2-4 ml of a solution of papaverine hydrochloride or dibazol is injected intramuscularly;

In case of heart rhythm disturbance, analeptics are prescribed - a solution of cordiamine (2-4 ml), camphor (up to 2 ml), potassium preparations panangin (up to 10 ml);

With shortness of breath, difficulty breathing - up to 10 ml of a 2.5% solution of aminophylline is injected intravenously.

A decrease in dyspeptic phenomena is achieved by introducing a solution of raglan (cerucal - up to 4 ml), as well as spasmalgesics - baralgin (up to 10 ml), NO-ShPy (up to 5 ml). A solution of baralgin, along with a 50% solution of analgin, is also indicated to reduce the severity of headaches.

With chills, sweating, a solution is injected nicotinic acid(Vit PP - up to 2 ml) or 10% calcium chloride solution - up to 10 ml.

Psychotropic drugs are used to stop affective, psychopathic and neurosis-like disorders. Relanium (dizepam, seduxen, sibazon) is administered intramuscularly, or at the end of intravenous infusion of solutions intravenously at a dose of up to 4 ml for withdrawal symptoms with anxiety, irritability, sleep disorders, autonomic disorders. Nitrazepam (eunoctin, radedorm - up to 20 mg), phenazepam (up to 2 mg), grandaxin (up to 600 mg) are given orally, it should be borne in mind that nitrazepam and phenazepam are best used to normalize sleep, and grandaxin for stopping autonomic disorders.

With severe affective disorders (irritability, a tendency to dysphoria, outbursts of anger), antipsychotics with a hypnotic-sedative effect are used (droperidol 0.25% - 2-4 ml).

With rudimentary visual or auditory hallucinations, paranoid mood in the structure of abstinence, 2-3 ml of a 0.5% solution of haloperidol is intramuscularly injected in combination with Relanium to reduce neurological side effects.

With severe motor anxiety, droperidol is used in 2-4 ml of a 0.25% solution intramuscularly or sodium oxybutyrate in 5-10 ml of a 20% solution intravenously. Antipsychotics from the group of phenothiazines (chlorpromazine, tizercin) and tricyclic antidepressants (amitriptyline) are contraindicated.

Therapeutic measures are carried out until there are signs of a clear improvement in the patient's condition (reduction of somato-vegetative, neurological, mental disorders, normalization of sleep) under constant monitoring of the function of the cardiovascular or respiratory system.

pacing

Cardiac pacing (ECS) is a method by which external electrical impulses produced by an artificial pacemaker (pacemaker) are applied to any part of the heart muscle, as a result of which the heart contracts.

Indications for pacing

· Asystole.

Severe bradycardia regardless of the underlying cause.

· Atrioventricular or Sinoatrial blockade with attacks of Adams-Stokes-Morgagni.

There are 2 types of pacing: permanent pacing and temporary pacing.

1. Permanent pacing

Permanent pacing is the implantation of an artificial pacemaker or cardioverter-defibrillator. Temporary pacing

2. Temporary pacing is necessary for severe bradyarrhythmias due to sinus node dysfunction or AV block.

Temporary pacing can be performed various methods. Currently relevant are transvenous endocardial and transesophageal pacing, and in some cases, external transcutaneous pacing.

Transvenous (endocardial) pacing has received especially intensive development, since it is the only effective way to “impose” an artificial rhythm on the heart in the event of severe disorders of the systemic or regional circulation due to bradycardia. When it is performed, the electrode under ECG control through the subclavian, internal jugular, ulnar or femoral vein injected into the right atrium or right ventricle.

Temporary atrial transesophageal pacing and transesophageal ventricular pacing (TEPS) have also become widespread. CHPES is used as replacement therapy with bradycardia, bradyarrhythmia, asystole and sometimes with reciprocal supraventricular arrhythmias. It is often used for diagnostic purposes. Temporary transthoracic pacing is sometimes used by emergency physicians to buy time. One electrode is inserted through a percutaneous puncture into the heart muscle, and the second is a needle placed subcutaneously.

Indications for temporary pacing

· Temporary pacing is carried out in all cases of indications for permanent pacing as a "bridge" to it.

Temporary pacing is performed when it is not possible to urgently implant a pacemaker.

Temporary pacing is carried out with hemodynamic instability, primarily in connection with Morgagni-Edems-Stokes attacks.

Temporary pacing is performed when there is reason to believe that bradycardia is transient (with myocardial infarction, the use of drugs that can inhibit the formation or conduction of impulses, after cardiac surgery).

Temporary pacing is recommended for the prevention of patients with acute myocardial infarction of the anterior septal region of the left ventricle with blockade of the right and anterior superior branch of the left branch of the bundle of His, due to increased risk the development of complete atrioventricular block with asystole due to the unreliability of the ventricular pacemaker in this case.

Complications of temporary pacing

Displacement of the electrode and the impossibility (cessation) of electrical stimulation of the heart.

Thrombophlebitis.

· Sepsis.

Air embolism.

Pneumothorax.

Perforation of the wall of the heart.

Cardioversion-defibrillation

Cardioversion-defibrillation (electropulse therapy - EIT) - is a transsternal effect of direct current of sufficient strength to cause depolarization of the entire myocardium, after which the sinoatrial node (first-order pacemaker) resumes control of the heart rhythm.

Distinguish between cardioversion and defibrillation:

1. Cardioversion - exposure to direct current, synchronized with the QRS complex. With various tachyarrhythmias (except for ventricular fibrillation), the effect of direct current should be synchronized with the QRS complex, because. in the case of current exposure before the peak of the T wave, ventricular fibrillation may occur.

2. Defibrillation. The impact of direct current without synchronization with the QRS complex is called defibrillation. Defibrillation is performed in ventricular fibrillation, when there is no need (and no opportunity) to synchronize the exposure to direct current.

Indications for cardioversion-defibrillation

Flutter and ventricular fibrillation. Electropulse therapy is the method of choice. Read more: Cardiopulmonary resuscitation at a specialized stage in the treatment of ventricular fibrillation.

Persistent ventricular tachycardia. In the presence of impaired hemodynamics (Morgagni-Adams-Stokes attack, arterial hypotension and / or acute heart failure), defibrillation is carried out immediately, and if it is stable, after an attempt to stop it with medications if it is ineffective.

Supraventricular tachycardia. Electropulse therapy is performed according to vital indications with progressive deterioration of hemodynamics or in a planned manner with the ineffectiveness of drug therapy.

· Atrial fibrillation and flutter. Electropulse therapy is performed according to vital indications with progressive deterioration of hemodynamics or in a planned manner with the ineffectiveness of drug therapy.

· Electropulse therapy is more effective in reentry tachyarrhythmias, less effective in tachyarrhythmias due to increased automatism.

· Electropulse therapy is absolutely indicated for shock or pulmonary edema caused by tachyarrhythmia.

Emergency electropulse therapy is usually performed in cases of severe (more than 150 per minute) tachycardia, especially in patients with acute myocardial infarction, with unstable hemodynamics, persistent anginal pain, or contraindications to the use of antiarrhythmic drugs.

The defibrillator should be equipped with all ambulance teams and all units medical institutions, and all health workers should own this method of resuscitation.

Cardioversion-defibrillation technique

In the case of a planned cardioversion, the patient should not eat for 6-8 hours to avoid possible aspiration.

Due to the pain of the procedure and the fear of the patient, general anesthesia or intravenous analgesia and sedation are used (for example, fentanyl at a dose of 1 mcg / kg, then midazolam 1-2 mg or diazepam 5-10 mg; elderly or debilitated patients - 10 mg promedol). With initial respiratory depression, non-narcotic analgesics are used.

When performing cardioversion-defibrillation, you must have the following kit on hand:

· Tools for maintaining airway patency.

· Electrocardiograph.

· Artificial lung ventilation apparatus.

· Medications and solutions required for the procedure.

· Oxygen.

The sequence of actions during electrical defibrillation:

The patient should be in a position that allows, if necessary, to carry out tracheal intubation and closed heart massage.

Reliable access to the patient's vein is required.

· Turn on the power, turn off the defibrillator timing switch.

· Set the required charge on the scale (approximately 3 J/kg for adults, 2 J/kg for children); charge the electrodes; lubricate the plates with gel.

· It is more convenient to work with two manual electrodes. Install electrodes on the anterior surface of the chest:

One electrode is placed above the zone of cardiac dullness (in women - outward from the apex of the heart, outside the mammary gland), the second - under the right clavicle, and if the electrode is dorsal, then under the left shoulder blade.

The electrodes can be placed in the anteroposterior position (along the left edge of the sternum in the area of ​​the 3rd and 4th intercostal spaces and in the left subscapular region).

The electrodes can be placed in the anterolateral position (between the clavicle and the 2nd intercostal space along the right edge of the sternum and above the 5th and 6th intercostal spaces, in the region of the apex of the heart).

· For maximum reduction of electrical resistance during electropulse therapy, the skin under the electrodes is degreased with alcohol or ether. In this case, gauze pads are used, well moistened with isotonic sodium chloride solution or special pastes.

The electrodes are pressed against the chest wall tightly and with force.

Perform cardioversion-defibrillation.

The discharge is applied at the moment of complete exhalation of the patient.

If the type of arrhythmia and the type of defibrillator allow, then the shock is delivered after synchronization with the QRS complex on the monitor.

Immediately before applying the discharge, you should make sure that the tachyarrhythmia persists, for which electrical impulse therapy is performed!

With supraventricular tachycardia and atrial flutter, a discharge of 50 J is sufficient for the first exposure. With atrial fibrillation or ventricular tachycardia, a discharge of 100 J is required for the first exposure.

In the case of polymorphic ventricular tachycardia or ventricular fibrillation, a discharge of 200 J is used for the first exposure.

While maintaining arrhythmia, with each subsequent discharge, the energy is doubled up to a maximum of 360 J.

The time interval between attempts should be minimal and is required only to assess the effect of defibrillation and set, if necessary, the next discharge.

If 3 discharges with increasing energy did not restore the heart rhythm, then the fourth - maximum energy - is applied after the intravenous administration of an antiarrhythmic drug indicated for this type of arrhythmia.

· Immediately after electropulse therapy, the rhythm should be assessed and, if it is restored, an ECG should be recorded in 12 leads.

If ventricular fibrillation continues, antiarrhythmic drugs are used to lower the defibrillation threshold.

Lidocaine - 1.5 mg / kg intravenously, by stream, repeat after 3-5 minutes. In case of restoration of blood circulation, a continuous infusion of lidocaine is carried out at a rate of 2-4 mg / min.

Amiodarone - 300 mg intravenously over 2-3 minutes. If there is no effect, you can repeat the intravenous administration of another 150 mg. In case of restoration of blood circulation, continuous infusion is carried out in the first 6 hours 1 mg / min (360 mg), in the next 18 hours 0.5 mg / min (540 mg).

Procainamide - 100 mg intravenously. If necessary, the dose can be repeated after 5 minutes (up to a total dose of 17 mg/kg).

Magnesium sulfate (Kormagnesin) - 1-2 g intravenously over 5 minutes. If necessary, the introduction can be repeated after 5-10 minutes. (with tachycardia of the "pirouette" type).

After the introduction of the drug for 30-60 seconds, general resuscitation is carried out, and then the electrical impulse therapy is repeated.

In case of intractable arrhythmias or sudden cardiac death, it is recommended to alternate the administration of drugs with electropulse therapy according to the scheme:

Antiarrhythmic drug - shock 360 J - adrenaline - shock 360 J - antiarrhythmic drug - shock 360 J - adrenaline, etc.

· You can apply not 1, but 3 discharges of maximum power.

· The number of digits is not limited.

In case of ineffectiveness, general resuscitation measures are resumed:

Perform tracheal intubation.

Provide venous access.

Inject adrenaline 1 mg every 3-5 minutes.

You can enter increasing doses of adrenaline 1-5 mg every 3-5 minutes or intermediate doses of 2-5 mg every 3-5 minutes.

Instead of adrenaline, you can enter intravenously vasopressin 40 mg once.

Defibrillator Safety Rules

Eliminate the possibility of grounding the personnel (do not touch the pipes!).

Exclude the possibility of touching others to the patient during the application of the discharge.

Make sure that the insulating part of the electrodes and hands are dry.

Complications of cardioversion-defibrillation

· Post-conversion arrhythmias, and above all - ventricular fibrillation.

Ventricular fibrillation usually develops in cases of shock in the vulnerable phase cardiac cycle. The probability of this is low (about 0.4%), however, if the patient's condition, the type of arrhythmia and technical capabilities allow, synchronization of the discharge with the R wave on the ECG should be used.

If ventricular fibrillation occurs, a second discharge with an energy of 200 J is immediately applied.

Other post-conversion arrhythmias (eg, atrial and ventricular extrasystoles) are usually transient and do not require special treatment.

Thromboembolism of the pulmonary artery and great circle circulation.

Thromboembolism often develops in patients with thromboendocarditis and with long-term atrial fibrillation in the absence of adequate preparation with anticoagulants.

Respiratory disorders.

Respiratory disorders are the result of inadequate premedication and analgesia.

To prevent the development of respiratory disorders, full oxygen therapy should be carried out. Often, developing respiratory depression can be dealt with with the help of verbal commands. Do not try to stimulate breathing with respiratory analeptics. In severe respiratory failure, intubation is indicated.

skin burns.

Skin burns occur due to poor contact of the electrodes with the skin, the use of repeated discharges with high energy.

Arterial hypotension.

Arterial hypotension after cardioversion-defibrillation rarely develops. Hypotension is usually mild and does not last long.

· Pulmonary edema.

Pulmonary edema occasionally occurs 1-3 hours after the restoration of sinus rhythm, especially in patients with long-term atrial fibrillation.

Changes in repolarization on the ECG.

Changes in repolarization on the ECG after cardioversion-defibrillation are multidirectional, non-specific, and can persist for several hours.

· Changes in biochemical analysis blood.

Increases in the activity of enzymes (AST, LDH, CPK) are mainly associated with the effect of cardioversion-defibrillation on skeletal muscles. The CPK MV activity increases only with multiple high-energy discharges.

Contraindications for EIT:

1. Frequent, short-term paroxysms of AF, which stop on their own or with medication.

2. Permanent form of atrial fibrillation:

More than three years old

The age is not known.

cardiomegaly,

Frederick Syndrome,

glycosidic toxicity,

TELA up to three months,

LIST OF USED LITERATURE

1. A.G. Miroshnichenko, V.V. Ruksin St. Petersburg medical Academy postgraduate education, St. Petersburg, Russia "Protocols of the medical and diagnostic process at the prehospital stage"

2. http://smed.ru/guides/67158/#Pokazaniya_k_provedeniju_kardioversiidefibrillyacii

3. http://smed.ru/guides/67466/#_Pokazaniya_k_provedeniju_jelektrokardiostimulyacii

4. http://cardiolog.org/cardiohirurgia/50-invasive/208-vremennaja-ecs.html

5. http://www.popumed.net/study-117-13.html

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

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

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

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

First aid for emergencies may not always be offered by qualified doctors or paramedics. Every contemporary must have the skills of pre-medical measures and know the symptoms of common diseases: the result depends on the quality and timeliness of measures, the level of knowledge, and the skills of witnesses of critical situations.

ABC algorithm

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

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

Article 11 federal law dated November 21, 2011 No. 323-FZ “On the basics of protecting the health of citizens in Russian Federation"(hereinafter referred to as Federal Law No. 323) indicates that emergency medical care 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 July 22, 1993 N 5487-1, became invalid on January 1, 2012), although the concept of "emergency medical care" appeared in it. What is emergency medical care?

Forms of medical care

Article 32 of the Federal Law No. 323 identifies the following forms of medical care:

emergency

Medical assistance provided in case of sudden acute diseases, conditions, exacerbation chronic diseases posing a threat to the life of the patient.

urgent

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

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.

The difference between the concepts of "emergency" and "urgent" care

An attempt to isolate emergency medical care from emergency, or emergency medical care familiar to each of us, was made by officials of the Ministry of Health and Social Development of Russia (since May 2012 - the Ministry of Health of the Russian Federation).

Approximately since 2007, we can talk about the beginning of some separation or differentiation of the concepts of "emergency" and "urgent" assistance 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. Extra urgent, emergency, emergency. Federal Law No. 323 put an end to this issue by approving three different forms of medical care: emergency, urgent and planned.

As you can see, emergency and emergency medical care are opposed to each other. At the moment, any medical organization is obliged to provide only emergency medical care free of charge and without delay. Are there any significant differences between the two discussed concepts? It is especially important to talk about fixing this difference at the normative level.

Cases of emergency and urgent care

According to ministry officials, emergency medical care is provided if the available pathological changes the patient is 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. They do not match only on the following points:

Emergency medical care

It turns out with sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the life of the patient, is a type of primary health care and is provided on an outpatient basis and in a day hospital. For this purpose, an emergency medical service is being created in the structure of medical organizations.

emergency medical care

It turns out with sudden acute diseases, conditions, exacerbation of chronic diseases that are life-threatening for the patient (in case of accidents, injuries, poisoning, complications of pregnancy and other conditions and diseases). According to the new law, emergency medical care is provided in an emergency or emergency form outside a medical organization, as well as on an outpatient and inpatient basis. emergency assistance are obliged to provide any medical organizations and medical workers.

The presence of a threat to life

Unfortunately, Federal Law No. 323 contains only the analyzed concepts themselves, and when introducing a new concept of separate provision of emergency and emergency medical care, a number of problems arise, the main of which is the difficulty of determining in practice the existence of a threat to life.

There was 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. 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.

The Need for a Regulatory Definition of a Threat to Life

Therefore, especially at the initial stage of the implementation of the concept that divides the flow of patients according to fuzzy guidelines, we can expect an increase in deaths. Hopefully, the most important details will soon be spelled out in by-laws.

At the moment, medical organizations should probably focus on 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 to develop local instructions for emergency medical care on the territory of the organization, with which all medical workers must be familiarized.

Emergency medical care costs

In accordance with paragraph 10 of Article 83 of 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 in the manner and in the amount established by the program of state guarantees of free provision to citizens medical care. However, it is worth noting that to date, the mechanism for such compensation at the legislative level has not been established.

Emergency Medical Licensing

After the entry into force of the 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 - the Order of the Ministry of Health No. 121n ) many citizens have a well-founded misconception that emergency medical care must be included in the license for medical activity. The type of medical service "emergency medical care", subject to licensing, is also indicated in the Decree of the Government of the Russian Federation of April 16, 2012 No. 291 "On Licensing Medical Activities".

Clarifications of the Ministry of Health of the Russian Federation on the issue of licensing emergency care

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. N 9.

"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 occur due to the development of shock, acute blood loss, respiratory disorders, circulatory disorders, coma, which are caused by acute diseases. 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.

Of particular importance is anything that can threaten your safety and the safety of others: exposed electrical wires, falling debris, intense road 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 humerus with an 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 limb loss. 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:

urgent first aid:

§ check airway patency, respiration, blood circulation;

§ arterial bleeding temporarily stop 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.

Emergency 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 massage hearts.

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 domestic dog and the presence of a small wound, carry out the toilet of the wound;

§ 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.