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

Types of medical care

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

• Emergency. It appears in the event that there is a threat to the life of the patient. This can be with an exacerbation of any chronic diseases or with sudden acute conditions.
• Urgent. It is necessary during the period of exacerbated chronic pathology or in case of an accident, but there is no threat to the life of the patient.

• Planned. This is the implementation of preventive and planned activities. At the same time, there is no threat to the patient's life even if the provision of this type of assistance is delayed.

Emergency and emergency care

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

In emergencies, medical attention is required. Depending on where the process takes place, in case of emergency, assistance is provided:

• External processes that arise under the influence of external factors and directly affect human life.
• internal processes. The result of pathological processes in the body.

Emergency care is one of the types of primary health care, provided during exacerbation of chronic diseases, in acute conditions that do not threaten the patient's life. It can be provided both on a day hospital and on an outpatient basis.

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

Emergency care must be provided in any medical facility.

Pre-hospital care is very important in emergency situations.

Major emergencies

Emergency conditions can be divided into several groups:

1. Injuries. These include:

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

2. Poisoning. Damage occurs within the body, unlike injuries, it is the result of external influences. Violation of the work of internal organs with untimely emergency care can lead to death.

Poison can enter the body:

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

Medical emergencies include:

1. Acute conditions of internal organs:

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

2. Anaphylactic shock.

3. Hypertensive crises.

4. Attacks of suffocation.

5. Hyperglycemia in diabetes mellitus.

Emergency conditions in pediatrics

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

Pediatric emergencies requiring medical attention:

• Convulsive syndrome.
• Fainting in a child.
• Coma in a child.
• collapse in a child.
• Pulmonary edema.
• The child is in shock.
• infectious fever.
• Asthmatic attacks.
• Croup syndrome.
• Incessant vomiting.
• Dehydration of the body.
• Emergency conditions in diabetes mellitus.

In these cases, the emergency medical service is called.

Features of emergency care for a child

The doctor's actions must be consistent. It must be remembered that in a child, the disruption of the work of individual organs or the whole organism occurs much faster than in an adult. Therefore, emergencies and emergency medical care in pediatrics require a quick response and coordinated action.

Adults should ensure the calm condition of the child and provide full cooperation in collecting information about the patient's condition.

The doctor should ask the following questions:

• Why did you seek emergency help?
• How was the injury received? If it's an injury.
• When did the child get sick?
• How did the disease develop? How did it go?
• What preparations and agents were used before the arrival of the doctor?

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

It should be borne in mind that in 50% of cases where the patient is a child, the diagnosis is made by the doctor based on the information collected, and only in 30% - as a result of the examination.

At the first stage, the doctor should:

• Assess the degree of disruption of the respiratory system and the work of the cardiovascular system. Determine the degree of need for emergency therapeutic measures according to vital signs.
• It is necessary to check the level of consciousness, breathing, the presence of convulsions and cerebral symptoms and the need for urgent measures.

You need to pay attention to the following points:

• How does the child behave?
• Sluggish or hyperactive.
• What an appetite.
• Condition of the skin.
• The nature of the pain, if any.

Medical emergencies and care

The health worker must be able to quickly assess emergencies, and emergency medical care must be provided in a timely manner. A correct and quick diagnosis is the key to a quick recovery.

Treatment emergencies include:

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

• Failure of the organs of the cardiovascular system.
• Asthma, various types of stenosis.
• Diseases of the brain.
• Epilepsy. Diabetes mellitus and other diseases.

Assistance is as follows:

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

2. Myocardial infarction. Symptoms: pain burning, squeezing, similar to an attack of angina pectoris. Pain attacks are undulating, decrease, but do not stop completely. The pain gets worse with every wave. At the same time, it can give to the shoulder, forearm, left shoulder blade or hand. There is also a feeling of fear, a breakdown.

Assistance is as follows:

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

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

The patient must be urgently admitted to an emergency medicine center.

3. Hypertensive crisis. Symptoms: headache, nausea, vomiting, goosebumps, numbness of the tongue, lips, hands. Double vision, weakness, lethargy, high blood pressure.

Emergency assistance is as follows:

• It is necessary to provide the patient with rest and good access to air.
• With crisis type 1 "Nifedipine" or "Clonidine" under the tongue.
• At high pressure intravenously "Clonidine" or "Pentamine" up to 50 mg.
• If tachycardia persists, - "Propranolol" 20-40 mg.
• In a type 2 crisis, Furosemide is administered intravenously.
• With convulsions, Diazepam is administered intravenously or Magnesium sulfate.

The doctor's task is to reduce the pressure by 25% of the initial one during the first 2 hours. With a complicated crisis, urgent hospitalization is necessary.

4. Coma. It may be of different types.

Hyperglycemic. Develops slowly, begins with weakness, drowsiness, headache. Then there is nausea, vomiting, increased thirst, itchy skin. Then loss of consciousness.

Urgent care:

• Eliminate dehydration, hypovolemia. Sodium chloride solution is injected intravenously.
• Intravenously administered "Insulin".
• With severe hypotension, a solution of 10% "Caffeine" subcutaneously.
• Carry out oxygen therapy.

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

Emergency care means:

• Ensuring complete rest.
• Intravenous administration of glucose.
• Correction of arterial pressure.
• Urgent hospitalization.

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

Emergency care is as follows:

• Position the patient so that the head is below the level of the legs.
• Provide air access.
• Open the airways, turn the head to the side, protrude the lower jaw.
• Introduce "Adrenaline", re-introduction is allowed after 15 minutes.
• "Prednisolone" in / in.
• Antihistamines.
• With bronchospasm, a solution of "Euphyllin" is administered.
• Urgent hospitalization.

6. Pulmonary edema. Symptoms: well expressed shortness of breath. Cough with white or yellow sputum. The pulse is fast. Seizures are possible. Breath is wheezing. Wet rales are heard, and in a serious condition "dumb lungs"

We provide emergency assistance.

• The patient should be in a sitting or semi-sitting position, legs lowered.
• Carry out oxygen therapy with defoamers.
• Enter / in "Lasix" in saline.
• Steroid hormones such as Prednisolone or Dexamethasone in saline.
• "Nitroglycerin" 1% intravenously.

Let's pay attention to emergency conditions in gynecology:

1. Ectopic pregnancy disturbed.
2. Torsion of the pedicle of an ovarian tumor.
3. Apoplexy of the ovary.

Consider the provision of emergency care for ovarian apoplexy:

• The patient should be in a supine position, with a raised head.
• Glucose and "Sodium chloride" are administered intravenously.

It is necessary to control indicators:

• Blood pressure.
• Heart rate.
• body temperature.
• Respiratory frequency.
• Pulse.

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

How are emergencies diagnosed?

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

The Glasgow scale is used when it is necessary to determine the impairment of consciousness. It evaluates:

• Eye opening.
• Speech.
• Motor responses to pain stimuli.

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

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

• Color of the skin.
• Color of mucous membranes.
• Breathing frequency.
• Movement during breathing of the muscles of the neck and upper shoulder girdle.
• Retraction of the intercostal spaces.

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

• Damage to vital organs.
• The amount of blood loss.
• Cold extremities.
• Symptom of "white spot".
• Decreased urine output.
• Decreased blood pressure.
• Violation of the acid-base balance.

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

Emergency Algorithm

For each patient, the methods of treatment are individual, but the algorithm of actions for emergency conditions must be performed for each patient.

The principle of action is as follows:

• Restoration of normal breathing and circulation.
• Help with bleeding.
• It is necessary to stop convulsions of psychomotor agitation.
• Anesthesia.
• Elimination of disorders that contribute to the failure of the heart rhythm and its conduction.
• Conducting infusion therapy to eliminate dehydration of the body.
• Decrease in body temperature or its increase.
• Conducting antidote therapy in acute poisoning.
• Strengthening natural detoxification.
• If necessary, enterosorption is carried out.
• Fixation of the damaged part of the body.
• Correct transportation.
• Constant medical supervision.

What to do before the doctor arrives

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

Action algorithm:

1. Eliminate the factor that threatens the health and life of the patient. Conduct an assessment of his condition.
2. Take urgent measures to restore vital functions: restoring breathing, artificial respiration, heart massage, stopping bleeding, applying a bandage, and so on.
3. Maintain vital functions until the ambulance arrives.
4. Transportation to the nearest medical facility.

1. Acute respiratory failure. It is necessary to carry out artificial respiration "mouth to mouth" or "mouth to nose". We tilt our head back, the lower jaw needs to be shifted. Close your nose with your fingers and take a deep breath into the victim's mouth. It is necessary to take 10-12 breaths.

2. Heart massage. The victim is in a supine position on his back. We stand on the side and put palm on palm on top of the chest at a distance of 2-3 fingers above the lower edge of the chest. Then we perform pressure so that the chest is displaced by 4-5 cm. Within a minute, 60-80 pressures must be done.

Consider the necessary emergency care for poisoning and injuries. Our actions in gas poisoning:

• First of all, it is necessary to take the person out of the polluted area.
• Loosen tight clothing.
• Assess the patient's condition. Check pulse, breathing. If the victim is unconscious, wipe the temples and give a sniff of ammonia. If vomiting has begun, then it is necessary to turn the head of the victim to one side.
• After the victim was brought to his senses, it is necessary to carry out inhalation with pure oxygen so that there are no complications.
• Then you can give hot tea, milk or slightly alkaline water to drink.

Help with bleeding:

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

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

Providing first aid for fractures and dislocations.

• With an open fracture, it is necessary to stop the bleeding and apply a splint.
• It is strictly forbidden to correct the position of the bones or remove fragments from the wound.
• Having fixed the place of injury, the victim must be taken to the hospital.
• A dislocation is also not allowed to be corrected on its own; a warm compress cannot be applied.
• It is necessary to apply cold or a wet towel.
• Rest the injured part of the body.

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

What should be in a first aid kit

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

The first aid kit must meet the following requirements:

• All medicines, medical instruments, as well as dressings should be in one special case or box that is easy to carry and transport.
• First aid kit should have many departments.
• Store in an easily accessible place for adults and out of the reach of children. All family members should know about her whereabouts.
• Regularly check the expiration dates of the drugs and replenish the used medicines and products.

What should be in the first aid kit:

1. Preparations for the treatment of wounds, antiseptics:

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

2. Sterile or plain gauze mask.

3. Sterile and non-sterile rubber gloves.

4. Analgesics and antipyretics: "Analgin", "Aspirin", "Paracetamol".

5. Antimicrobials: Levomycetin, Ampicillin.

6. Antispasmodics: Drotaverine, Spazmalgon.

7. Cardiac drugs: "Corvalol", "Validol", "Nitroglycerin".

8. Adsorbents: "Atoxil", "Enterosgel".

9. Antihistamines: Suprastin, Dimedrol.

10. Ammonia.

11. Medical instruments:

• Clamp.
• Scissors.
• Cooling package.
• Disposable sterile syringe.
• Tweezers.

12. Antishock drugs: Adrenaline, Eufillin.

13. Antidotes.

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

Foreign bodies

Foreign body of the outer ear, as a rule, does not pose a danger to the patient and does not require urgent removal. Unskillful attempts to remove a foreign body are dangerous. It is forbidden to use tweezers to remove round objects; only an elongated foreign body (match) can be removed with tweezers. With living foreign bodies, it is recommended to infuse heated sunflower or vaseline oil into the external auditory canal, which leads to the death of the insect. Before removing swollen foreign bodies (peas, beans), to dehydrate them, a few drops of ethyl alcohol heated to 70 ° are first poured into the ear. Removal of a foreign body is carried out by washing the ear with warm water or a disinfectant solution (potassium permanganate, furatsilin) ​​from a Janet syringe or a rubber balloon. A jet of liquid is directed along the upper-posterior wall of the external auditory canal, along with the liquid, a foreign body is removed. While washing the ear, the head should be well fixed. Washing the ear is contraindicated in case of perforation of the tympanic membrane, complete obstruction of the ear canal with a foreign body, foreign objects of pointed shape (metal shavings).

on hit foreign body in the nasal passage close the opposite nostril and ask the child, straining hard, to blow his nose. If a foreign body remains, then only a doctor can remove it from the nasal cavity. Repeated attempts to remove a foreign body and instrumental interventions at the prehospital stage are contraindicated, as they can lead to pushing foreign objects into the lower parts of the respiratory tract, blocking them and causing suffocation.

On hit foreign body in the lower respiratory tract a young child is turned upside down, holding the legs, making shaking movements, trying to remove a foreign object. Older children, if it was not possible to get rid of a foreign body when coughing, perform one of the methods:

The child is laid on his stomach on the bent knee of an adult, the head of the victim is lowered down and lightly tapped on the back with a hand;

The patient is clasped with the left hand at the level of the costal arch and 3-4 blows are applied with the palm of the right hand along the spine between the shoulder blades;

An adult grabs the child from the back with both hands, brings his hands into the lock and places them slightly below the costal arch, then sharply presses the victim to himself, trying to put maximum pressure on the epigastric region;

If the patient is unconscious, he is turned over on his side, 3-4 sharp and strong blows are performed with the palm of the hand on the spine between the shoulder blades.

In any case, you need to call a doctor.

Stenosing laryngotracheitis

Emergency first aid for prestenosing laryngotracheitis is aimed at restoring airway patency. They try to remove or reduce the phenomena of stenosis of the larynx with the help of distracting procedures. Alkaline or steam inhalations are carried out, warm foot and hand baths (temperature from 37 ° C with a gradual increase to 40 ° C), hot water or semi-alcohol compresses on the neck and calf muscles. In the absence of an increase in body temperature, a general hot bath is carried out in compliance with all precautions. Give warm alkaline drink in small portions. Provide access to fresh air.

Artificial lung ventilation

The most important condition for the successful implementation of artificial respiration is to ensure the patency of the respiratory tract. The child is laid on his back, the neck, chest and stomach of the patient are freed from restrictive clothing, the collar and belt are unbuttoned. The oral cavity is freed from saliva, mucus, vomit. Then one hand is placed on the parietal region of the victim, the other hand is placed under the neck and the child's head is thrown back as much as possible. If the patient's jaws are tightly closed, the mouth is opened by pushing the lower jaw forward and pressing the cheekbones with the index fingers.

When using the method mouth to nose the child's mouth is tightly closed with the palm of his hand and, after a deep breath, an energetic exhalation is made, clasping the victim's nose with his lips. When applying the method mouth to mouth pinch the nose of the patient with the thumb and forefinger, inhale the air deeply and, hermetically pressing their mouth to the child's mouth, exhale into the victim's mouth, having previously covered it with gauze or a handkerchief. Then the patient's mouth and nose are slightly opened, after which the patient is passively exhaled. Artificial respiration for newborns is carried out at a frequency of 40 breaths per minute, for young children - 30, for older children - 20.

During artificial lung ventilation Holger-Nielsen method the child is laid on the stomach, pressed with their hands on the patient's shoulder blades (exhale), then the victim's arms are pulled out (inhale). Artificial respiration Sylvester's way perform in the position of the child on the back, the victim's arms are crossed on the chest and pressed on the sternum (exhale), then the patient's arms are straightened (inhale).

Indirect cardiac massage

The patient is laid on a hard surface, freed from clothing, the belt is unfastened. With arms straightened at the elbow joints, they press on the lower third of the child's sternum (two transverse fingers above the xiphoid process). Squeezing is performed with the palmar part of the hand, putting one palm on top of the other, the fingers of both hands are lifted. For newborns, an indirect heart massage is performed with two thumbs of both hands or the index and middle fingers of one hand. Pressing on the sternum is carried out with quick rhythmic pushes. The compression force should ensure the displacement of the sternum towards the spine in newborns by 1-2 cm, young children - 3-4 cm, older children - 4-5 cm. The frequency of pressure corresponds to the age-related heart rate.

Pulmonary heart resuscitation

Stages of cardiopulmonary resuscitation;

Stage I - restoration of airway patency;

Stage II - artificial ventilation of the lungs;

Stage III - indirect heart massage.

If one person performs cardiopulmonary resuscitation, then after 15 chest compressions, he produces 2 artificial breaths. If resuscitating two, the ratio of pulmonary ventilation / cardiac massage is 1:5.

The criteria for the effectiveness of cardiopulmonary resuscitation are:

The appearance of the reaction of the pupils to light (narrowing);

Restoration of pulsation in the carotid, radial, femoral arteries;

Increased blood pressure;

The appearance of independent respiratory movements;

Restoration of the normal color of the skin and mucous membranes;

Return of consciousness.

Fainting

When fainting, the child is given a horizontal position with a slightly lowered head and raised legs in order to improve the blood supply to the brain. Free from tight clothing, unbutton the collar, belt. Provide access to fresh air, open windows and doors wide, or take the child out into the open air. Sprinkle face with cold water, pat on the cheeks. They give you a sniff of cotton wool moistened with ammonia.

Collapse

Measures to provide emergency care in case of collapse before the doctor arrives include giving the child a horizontal position on the back with raised lower limbs, wrapping in a warm blanket, warming with heating pads.

Paroxysmal tachycardia

To relieve an attack of paroxysmal tachycardia, techniques are used that cause irritation of the vagus nerve. The most effective methods are straining the child at the height of a deep breath (Valsava test), affecting the carotid sinus zone, pressing on the eyeballs (Ashner's reflex), and artificially inducing vomiting.

Internal bleeding

Sick with hemoptysis and pulmonary hemorrhage give a semi-sitting position with lowered legs, forbid moving, talking, straining. They release from clothing that restricts breathing, provide an influx of fresh air, for which the windows are wide open. The child is recommended to swallow small pieces of ice, drink cold water in small portions. Apply an ice pack to the chest.

At gastrointestinal bleeding appoint a strict bed rest, prohibit the intake of food and liquids. An ice pack is placed on the abdomen. Carry out constant monitoring of the frequency and filling of the pulse, the level of blood pressure.

Urgent hospitalization indicated.

External bleeding

child with nosebleed give a semi-sitting position. It is forbidden to blow your nose. A cotton ball moistened with a 3% hydrogen peroxide solution or a hemostatic sponge is introduced into the vestibule of the nose. The wing of the nose is pressed against the nasal septum. Ice or gauze soaked in cold water is placed on the back of the head and bridge of the nose.

The main urgent action in external traumatic bleeding is a temporary stop of bleeding. Arterial bleeding from the vessels of the upper and lower extremities is stopped in two stages: first, the artery is pressed above the injury site to the bone protrusion, then a standard rubber or impromptu tourniquet is applied.

To clamp the brachial artery, the fist is placed in the armpit and the hand is pressed against the body. A temporary stop of bleeding from the arteries of the forearm is achieved by laying the roller (packaging of the bandage) in the elbow bend and maximum bending of the arm in the elbow joint. In case of damage to the femoral artery, the fist is pressed on the upper third of the thigh in the region of the inguinal (pupart) ligament. Pressing the arteries of the lower leg and foot is carried out by inserting a roller (package of a bandage) into the popliteal region and maximum flexion of the leg at the knee joint.

After pressing the arteries, they begin to apply a hemostatic tourniquet, which is applied over clothing or a towel, a scarf, a piece of gauze. The tourniquet is brought under the limb above the wound site, strongly stretched and, without reducing the tension, tightened around the limb, fixed. If the tourniquet is applied correctly, bleeding from the wound stops, the pulse on the radial artery or dorsal artery of the foot disappears, the distal limbs turn pale. It should be remembered that excessive tightening of the tourniquet, especially on the shoulder, can cause paralysis of the peripheral parts of the limb due to damage to the nerve trunks. A note is placed under the tourniquet indicating the time the tourniquet was applied. After 20-30 minutes, the tourniquet pressure can be weakened. A tourniquet applied to a soft pad should not be on the limb for more than 1 hour.

Arterial bleeding from the arteries of the hand and foot does not require the mandatory application of a tourniquet. It is enough to tightly bandage a tight roller of sterile wipes (a pack of sterile bandage) to the wound site and give the limb an elevated position. The tourniquet is used only for extensive multiple wounds and crush injuries of the hand and foot. Wounds of the digital arteries are stopped with a tight pressure bandage.

Arterial bleeding in the scalp (temporal artery), on the neck (carotid artery) and torso (subclavian and iliac arteries) is stopped by tight tamponade of the wound. With tweezers or a clamp, the wound is tightly packed with napkins, on top of which you can apply an unfolded bandage from a sterile package and bandage it as tightly as possible.

Venous and capillary bleeding is stopped by applying a tight pressure bandage. If a large main vein is damaged, it is possible to produce a tight tamponade of the wound or apply a hemostatic tourniquet.

Acute urinary retention

Emergency care for acute urinary retention is the speedy removal of urine from the bladder. Independent urination is facilitated by the sound of pouring water from a tap, irrigation of the genital organs with warm water. In the absence of contraindications, a warm heating pad is placed on the pubic area or the child is seated in a warm bath. In case of ineffectiveness of these measures, they resort to bladder catheterization.

hyperthermia

During the period of maximum increase in body temperature of the child, it is necessary to drink often and plentifully: they give liquid in the form of fruit juices, fruit drinks, mineral waters. With an increase in body temperature above 37 ° C, for each degree, additional fluid is required at the rate of 10 ml per 1 kg of the child's body weight. Cracks on the lips are smeared with vaseline or other oil. Provide meticulous oral care.

With a "pale" type of fever, the child develops chills, the skin is pale, the extremities are cold. The patient is first of all warmed, covered with a warm blanket, heating pads are applied, and warm drinks are given.

For the "red" type of fever is characterized by a feeling of heat, the skin is warm, moist, blush on the cheeks. In such cases, to increase heat transfer, physical methods are used to reduce body temperature: the child is undressed, air baths are carried out, the skin is wiped with a half-alcohol solution or a solution of table vinegar, the head and liver area is cooled with an ice pack or a cold compress.

Overheating (heat stroke) can occur in a child who is in a poorly ventilated room with high air temperature and humidity, with intense physical work in stuffy rooms. Contribute to overheating warm clothes, non-compliance with the drinking regime, overwork. In infants, heat stroke can occur when wrapped in warm blankets, when a crib (or stroller) is near a central heating radiator or stove.

Signs of heat stroke depend on the presence and degree of hyperthermia. With mild overheating, the condition is satisfactory. Body temperature is not elevated. Patients complain of headache, weakness, dizziness, tinnitus, thirst. The skin is moist. Respiration and pulse are somewhat quickened, blood pressure is within normal limits.

With a significant degree of overheating, a severe headache is disturbed, nausea and vomiting often occur. A short-term loss of consciousness is possible. The skin is moist. Respiration and pulse are quickened, blood pressure is increased. Body temperature reaches 39-40°C.

Severe overheating is characterized by an increase in body temperature up to 40 ° C and above. Patients are excited, delirium, psychomotor agitation is possible, contact with them is difficult. In infants, diarrhea, vomiting often occur, facial features are sharpened, the general condition quickly worsens, convulsions, and a coma are possible. A characteristic sign of a severe degree of overheating is the cessation of sweating, the skin is moist and dry. Breathing is frequent, shallow. Respiratory arrest is possible. The pulse is sharply accelerated, blood pressure is reduced.

When signs of heat stroke appear, the patient is urgently taken out to a cool place, provide access to fresh air. The child is undressed, given a cold drink, a cold compress is placed on his head. In more severe cases, wrapping sheets soaked in cold water, dousing with cool water, applying ice to the head and groin area, and hospitalization are indicated.

Sunstroke occurs in children who are in the sun for a long time. At present, the concepts of "thermal" and "sunstroke" are not separated, since in both cases changes occur due to the general overheating of the body.

Emergency care for sunstroke is similar to that given to people with heat stroke. In severe cases, urgent hospitalization is indicated.

Cold defeat found in various climatic zones. This problem is especially urgent for the regions of the Far North and Siberia, however, cold injury can also be observed in regions with a relatively high average annual temperature. Cold can have a general and local effect on the child's body. The general effect of cold leads to the development of general cooling (freezing), and the local effect causes frostbite.

General cooling or freezing- such a state of the human body, in which, under the influence of adverse external conditions, the body temperature drops to + 35 ° C and below. At the same time, against the background of a decrease in body temperature (hypothermia), functional disorders develop in the body with a sharp inhibition of all vital functions, up to complete extinction.

All victims, regardless of the degree of general cooling, should be hospitalized. It should be borne in mind that victims with a mild degree of freezing may refuse hospitalization, as they do not adequately assess their condition. The main principle of treatment with general cooling is warming. At the prehospital stage, first of all, further cooling of the victim is prevented. For this, the child is immediately brought into a warm room or into a car, wet clothes are removed, wrapped in a blanket, covered with heating pads, and hot sweet tea is given. In no case should you leave the victim on the street, rub with snow, drink alcoholic beverages. In the absence of signs of respiration and circulation at the prehospital stage, the entire complex of cardiopulmonary resuscitation is performed against the background of warming the victim.

frostbite occurs with local prolonged exposure to low temperatures. The exposed parts of the body (nose, ears) and extremities are most often affected. There is a circulatory disorder, first of the skin, and then of the deeper tissues, necrosis develops. Depending on the severity of the lesion, there are four degrees of frostbite. I degree is characterized by the appearance of edema and hyperemia with a bluish tinge. At the II degree, blisters are formed, filled with light exudate. III degree of frostbite is characterized by the appearance of blisters with hemorrhagic contents. With IV degree frostbite, all layers of the skin, soft tissues and bones die.

The injured child is brought into a warm room, shoes and mittens are removed. A heat-insulating aseptic bandage is applied to the affected area of ​​the nose, auricle. The frostbitten limb is first rubbed with a dry cloth, then placed in a basin with warm (32-34°C) water. Within 10 min the temperature is brought to 40-45°C. If the pain that occurs during warming passes quickly, the fingers take on a normal appearance or are slightly swollen, sensitivity is restored - the limb is wiped dry, wiped with a half-alcohol solution, put on cotton, and warm woolen socks or mittens on top. If warming is accompanied by increasing pain, the fingers remain pale and cold, which indicates a deep degree of frostbite - the affected child is hospitalized.

poisoning

Providing first aid to children with acute poisoning is aimed at the accelerated removal of toxic substances from the body. For this purpose, stimulate vomiting, wash the stomach and intestines, force diuresis. Stimulation of vomiting is carried out only in children who are fully conscious. After taking the maximum possible amount of water, the posterior pharyngeal wall is irritated with a finger or a spoon. Stimulation of vomiting is facilitated by the use of a warm solution of table salt (1 tablespoon per glass of water). The procedure is repeated until the complete disappearance of impurities and the appearance of pure water. Gastric lavage is the main measure of elimination of toxic substances and should be performed as early as possible. When ingesting strong acids (sulfuric, hydrochloric, nitric, oxalic, acetic), gastric lavage is carried out with cold water using a probe lubricated with vaseline or vegetable oil. In case of alkali poisoning (ammonia, ammonia, bleach, etc.), the stomach is washed with cold water or a weak solution (1-2%) of acetic or citric acid through a probe lubricated with vaseline or vegetable oil, after cleansing, enveloping agents are introduced into the stomach cavity ( mucous decoctions, milk) or sodium bicarbonate. To cleanse the intestines, a saline laxative is used, cleansing enemas are performed. Forcing diuresis at the prehospital stage is achieved by prescribing plenty of fluids.

In order to change the metabolism of a poisonous substance in the body and reduce its toxicity, antidote therapy is used. As an antidote for poisoning with organophosphorus compounds (chlorophos, dichlorvos, karbofos, etc.), atropine is used, for poisoning with atropine (belladonna, henbane, belladonna) - pilocarpine, in case of poisoning with copper and its compounds (copper sulfate) - unithiol.

In case of poisoning with inhaled toxic substances (gasoline, kerosene), carbon monoxide (carbon monoxide), the child is taken out of the room, fresh air is provided, and oxygen therapy is carried out.

Emergency care for poisoning with poisonous mushrooms involves washing the stomach and intestines with the introduction of a saline laxative, a suspension of an enterosorbent. In case of fly agaric poisoning, atropine is additionally administered.

burns

At thermal burns of the skin it is necessary to stop exposure to the thermal agent. When clothing is ignited, the fastest and most effective means of extinguishing is to douse the victim with water or throw a tarp, blanket, etc. on. The clothes from the damaged areas of the body are carefully removed (cut with scissors without touching the wound surface). Pieces of clothing that adhere tightly to the burnt skin are carefully cut off. The burnt area is cooled with cold running water or an ice pack is used. Bubbles should not be opened or cut. Ointments, powders, oil solutions are contraindicated. Aseptic dry or wet-drying dressings are applied to the burn surface. In the absence of dressing material, the affected area of ​​the skin is wrapped with a clean cloth. Victims with deep burns are hospitalized.

At chemical burns of the skin caused by acids and alkalis, the most versatile and most effective means of providing first aid is a long-term washing of the burnt area with plenty of running water. Quickly remove clothing soaked in a chemical agent while continuing to wash the burnt skin surface. Contact with water is contraindicated for burns caused by quicklime and organic aluminum compounds. For alkali burns, burn wounds are washed with a weak solution of acetic or citric acid. If the damaging agent was acid, then a weak solution of sodium bicarbonate is used for washing.

electrical injury

First aid for electric shock is to eliminate the damaging effect of the current. They urgently turn off the switch, cut, chop or discard the wires, using objects with a wooden handle for this. When releasing a child from the effects of electric current, one should observe one's own safety, do not touch the exposed parts of the victim's body, use rubber gloves or dry rags wrapped around hands, rubber shoes, be on a wooden floor or a car tire. In the absence of breathing and cardiac activity in the child, they immediately begin to perform artificial ventilation of the lungs and chest compressions. A sterile bandage is applied to the electrical burn wound.

Drowning

The injured child is removed from the water. The success of resuscitation activities largely depends on their correct and timely implementation. It is desirable that they begin not on the shore, but already on the water, while the child is being towed to the shore. Even a few artificial breaths carried out during this period significantly increase the likelihood of a subsequent revival of the drowned person.

More perfect assistance to the victim can be provided in a boat (boat, cutter) or on the shore. In the absence of consciousness in the child, but the preservation of breathing and cardiac activity, they are limited to releasing the victim from restrictive clothing and using ammonia. Lack of spontaneous breathing and cardiac activity require the immediate implementation of artificial lung ventilation and chest compressions. Previously, the oral cavity is cleaned of foam, mucus, sand, silt. To remove the water that has entered the respiratory tract, the child is laid on his stomach on the assisting thigh bent at the knee joint, the head is lowered down and, supporting the head of the victim with one hand, the other hand is lightly hit several times between the shoulder blades. Or, with sharp jerky movements, they compress the lateral surfaces of the chest (for 10-15 seconds), after which the child is again turned onto his back. These preparatory measures are carried out as quickly as possible, then they begin to carry out artificial respiration and chest compressions.

Bites of poisonous snakes

When bitten by poisonous snakes, the first drops of blood are squeezed out of the wound, then cold is applied to the bite site. It is necessary that the affected limb remain motionless, since movements increase lymph flow and accelerate the entry of poison into the general circulation. The victim is provided with rest, the affected limb is fixed with a splint or improvised means. You should not cauterize the bite site, chip it with any drugs, bandage the affected limb above the bite site, suck out the poison, etc. Urgent admission to the nearest hospital is indicated.

Insect bites

In case of insect bites (bees, wasps, bumblebees), the sting of the insect is removed from the wound with tweezers (in its absence, with fingers). The bite site is moistened with a half-alcohol solution, cold is applied. Drug therapy is carried out according to the doctor's prescription.

CONTROL QUESTIONS

What is the help when a foreign body enters the nasal passages and respiratory tract?

What should be the first aid for stenosis of the larynx?

What are the methods of artificial lung ventilation?

What measures should be taken in case of cardiac arrest?

Determine the sequence of actions when performing cardiopulmonary resuscitation.

What measures can be taken to bring a child out of a state of fainting?

What emergency care is provided for poisoning?

What measures are taken in case of acute urinary retention?

What methods of temporarily stopping external bleeding do you know?

What are the ways to reduce body temperature?

What is frostbite relief?

What first aid is provided for thermal burns?

How to help a child with an electrical injury?

What measures should be taken in case of drowning?

What is the help for insect bites and poisonous snakes?

Clinical manifestations

First aid

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

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

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

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

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

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

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

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

With a convulsive form of a crisis:

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

2) antihypertensive drugs and diuretics - according to indications.

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

Notes

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

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

angina pectoris

Clinical manifestations s - m. Nursing in therapy.

First aid

1) stop physical activity;

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

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

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

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

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

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

myocardial infarction

Clinical manifestations- see Nursing in Therapy.

First aid

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

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

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

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

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

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

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

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

Pulmonary edema

Clinical manifestations

It is necessary to differentiate pulmonary edema from cardiac asthma.

1. Clinical manifestations of cardiac asthma:

1) frequent shallow breathing;

2) expiration is not difficult;

3) orthopnea position;

4) during auscultation, dry or wheezing rales.

2. Clinical manifestations of alveolar pulmonary edema:

1) suffocation, bubbling breath;

2) orthopnea;

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

4) tachycardia;

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

First aid

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

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

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

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

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

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

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

8) inject 60–90 mg of prednisolone intravenously;

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

10) hospitalize the patient.

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

Fainting

Clinical manifestations

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

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

First aid

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

2) unfasten the belt, collar, buttons;

3) spray your face and chest with cold water;

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

5) let the patient inhale vapors of ammonia;

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

Bronchial asthma (attack)

Clinical manifestations- see Nursing in Therapy.

First aid

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

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

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

4) carry out inhalation with an aerosol of bronchodilators;

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

asthmatic status

Clinical manifestations- see Nursing in Therapy.

First aid

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

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

3) when breathing stops - IVL;

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

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

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

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

Notes

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

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

Pulmonary bleeding

Clinical manifestations

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

First aid

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

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

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

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

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

Hypoglycemic coma

Clinical manifestations

2. The dynamics of the development of a coma:

1) feeling of hunger without thirst;

2) anxious anxiety;

3) headache;

4) increased sweating;

5) excitement;

6) stunning;

7) loss of consciousness;

8) convulsions.

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

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

First aid

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

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

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

4) patients are subject to hospitalization:

a) at the first appeared hypoglycemic condition;

b) when hypoglycemia occurs in a public place;

c) with the ineffectiveness of emergency medical measures.

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

Hyperglycemic (diabetic) coma

Clinical manifestations

1. History of diabetes mellitus.

2. Development of a coma:

1) lethargy, extreme fatigue;

2) loss of appetite;

3) indomitable vomiting;

4) dry skin;

6) frequent copious urination;

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

8) adynamia, drowsiness;

9) stupor, coma.

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

4. Tongue crimson with a dirty gray coating.

5. The smell of acetone in the exhaled air.

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

First aid

Sequencing:

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

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

Acute abdomen

Clinical manifestations

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

2. Soreness on palpation of the anterior abdominal wall.

3. Symptoms of peritoneal irritation.

4. Tongue dry, furred.

5. Subfebrile condition, hyperthermia.

First aid

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

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

Gastrointestinal bleeding

Clinical manifestations

1. Paleness of the skin, mucous membranes.

2. Vomiting blood or "coffee grounds".

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

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

5. Tachycardia, hypotension.

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

First aid

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

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

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

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

5) cardiac glycosides according to indications;

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

Renal colic

Clinical manifestations

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

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

3. Dysuric disorders.

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

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

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

7. Kidney stone disease in history.

First aid

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

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

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

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

Anaphylactic shock

Clinical manifestations

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

2. Feeling of fear of death.

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

4. Nausea, vomiting.

5. Seizures.

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

7. Tachycardia, thready pulse, arrhythmia.

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

9. Coma.

First aid

Sequencing:

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

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

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

4) carry out oxygen therapy with 100% oxygen;

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

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

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

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

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

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

11) with laryngospasm and asphyxia - conicotomy;

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

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

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

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

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

Quincke's edema

Clinical manifestations

1. Communication with the allergen.

2. Itchy rash on various parts of the body.

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

4. Puffiness and cyanosis of the face and neck.

6. Mental excitement, restlessness.

First aid

Sequencing:

1) stop introducing the allergen into the body;

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

3) administer 60–90 mg of prednisolone intravenously;

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

5) inhalation with bronchodilators (fenoterol);

6) be ready for conicotomy;

7) to hospitalize the patient.

ALGORITHMS FOR PROVIDING FIRST MEDICAL AID IN EMERGENCY CONDITIONS

FAINTING
Fainting is an attack of short-term loss of consciousness due to transient cerebral ischemia associated with a weakening of cardiac activity and an acute dysregulation of vascular tone. Depending on the severity of the factors contributing to the violation of cerebral circulation.
There are: cerebral, cardiac, reflex and hysterical types of fainting.
Stages of development of fainting.
1. Harbingers (pre-syncope). Clinical manifestations: discomfort, dizziness, tinnitus, shortness of breath, cold sweat, numbness of the fingertips. Lasts from 5 seconds to 2 minutes.
2. Violation of consciousness (actual fainting). Clinic: loss of consciousness lasting from 5 seconds to 1 minute, accompanied by pallor, decreased muscle tone, dilated pupils, their weak reaction to light. Breathing shallow, bradypnea. The pulse is labile, more often bradycardia is up to 40-50 per minute, systolic blood pressure drops to 50-60 mm. rt. Art. With deep fainting, convulsions are possible.
3. Post-fainting (recovery) period. Clinic: correctly oriented in space and time, pallor, rapid breathing, labile pulse and low blood pressure may persist.

2. Unbutton the collar.
3. Provide access to fresh air.
4. Wipe your face with a damp cloth or spray with cold water.
5. Inhalation of ammonia vapors (reflex stimulation of the respiratory and vasomotor centers).
In case of ineffectiveness of the above measures:
6. Caffeine 2.0 IV or IM.
7. Cordiamin 2.0 i/m.
8. Atropine (with bradycardia) 0.1% - 0.5 s / c.
9. When recovering from fainting, continue dental manipulations with measures to prevent relapse: treatment should be carried out with the patient in a horizontal position with adequate premedication and sufficient anesthesia.

COLLAPSE
Collapse is a severe form of vascular insufficiency (decrease in vascular tone), manifested by a decrease in blood pressure, dilation of venous vessels, a decrease in the volume of circulating blood and its accumulation in blood depots - capillaries of the liver, spleen.
Clinical picture: a sharp deterioration in the general condition, severe pallor of the skin, dizziness, chills, cold sweats, a sharp decrease in blood pressure, frequent and weak pulse, frequent, shallow breathing. Peripheral veins become empty, their walls collapse, which makes it difficult to perform venipuncture. Patients retain consciousness (during fainting, patients lose consciousness), but are indifferent to what is happening. Collapse can be a symptom of such severe pathological processes as myocardial infarction, anaphylactic shock, bleeding.

Algorithm of therapeutic measures
1. Give the patient a horizontal position.
2. Provide fresh air supply.
3. Prednisolone 60-90 mg IV.
4. Norepinephrine 0.2% - 1 ml IV in 0.89% sodium chloride solution.
5. Mezaton 1% - 1 ml IV (to increase venous tone).
6. Korglucol 0.06% - 1.0 IV slowly in 0.89% sodium chloride solution.
7. Polyglukin 400.0 IV drip, 5% glucose solution IV drip 500.0.

HYPERTENSIVE CRISIS
Hypertensive crisis is a sudden rapid increase in blood pressure, accompanied by clinical symptoms from target organs (often the brain, retina, heart, kidneys, gastrointestinal tract, etc.).
clinical picture. Sharp headaches, dizziness, tinnitus, often accompanied by nausea and vomiting. Visual impairment (grid or fog before the eyes). The patient is excited. In this case, there is trembling of the hands, sweating, a sharp reddening of the skin of the face. The pulse is tense, blood pressure is increased by 60-80 mm Hg. compared to normal. During a crisis, angina attacks, acute cerebrovascular accident may occur.

Algorithm of therapeutic measures
1. Intravenously in one syringe: dibazol 1% - 4.0 ml with papaverine 1% - 2.0 ml (slowly).
2. In severe cases: clonidine 75 mcg under the tongue.
3. Intravenous Lasix 1% - 4.0 ml in saline.
4. Anaprilin 20 mg (with severe tachycardia) under the tongue.
5. Sedatives - Elenium inside 1-2 tablets.
6. Hospitalization.

It is necessary to constantly monitor blood pressure!

ANAPHYLACTIC SHOCK
A typical form of drug-induced anaphylactic shock (LASH).
The patient has an acute state of discomfort with vague painful sensations. There is a fear of death or a state of inner unrest. There is nausea, sometimes vomiting, coughing. Patients complain of severe weakness, tingling and itching of the skin of the face, hands, head; a feeling of a rush of blood to the head, face, a feeling of heaviness behind the sternum or chest compression; the appearance of pain in the heart, difficulty breathing or the inability to exhale, dizziness or headache. Disorder of consciousness occurs in the terminal phase of shock and is accompanied by impaired verbal contact with the patient. Complaints occur immediately after taking the drug.
The clinical picture of LASH: hyperemia of the skin or pallor and cyanosis, swelling of the eyelids of the face, profuse sweating. Noisy breathing, tachypnea. Most patients develop restlessness. Mydriasis is noted, the reaction of pupils to light is weakened. The pulse is frequent, sharply weakened in the peripheral arteries. Blood pressure decreases rapidly, in severe cases, diastolic pressure is not detected. There is shortness of breath, shortness of breath. Subsequently, the clinical picture of pulmonary edema develops.
Depending on the severity of the course and the time of development of symptoms (from the moment of antigen administration), lightning-fast (1-2 minutes), severe (after 5-7 minutes), moderate (up to 30 minutes) forms of shock are distinguished. The shorter the time from drug administration to the onset of the clinic, the more severe the shock, and the less chance of a successful outcome of treatment.

Algorithm of therapeutic measures
Urgently provide access to the vein.
1. Stop the administration of the drug that caused anaphylactic shock. Call for an ambulance.
2. Lay the patient down, raise the lower limbs. If the patient is unconscious, turn his head to the side, push the lower jaw. Humidified oxygen inhalation. Ventilation of the lungs.
3. Intravenously inject 0.5 ml of 0.1% adrenaline solution in 5 ml of isotonic sodium chloride solution. If venipuncture is difficult, adrenaline is injected into the root of the tongue, possibly intratracheally (puncture of the trachea below the thyroid cartilage through the conical ligament).
4. Prednisolone 90-120 mg IV.
5. Diphenhydramine solution 2% - 2.0 or suprastin solution 2% - 2.0, or diprazine solution 2.5% - 2.0 i.v.
6. Cardiac glycosides according to indications.
7. In case of airway obstruction - oxygen therapy, 2.4% solution of eufillin 10 ml intravenously in saline solution.
8. If necessary - endotracheal intubation.
9. Hospitalization of the patient. Allergy identification.

TOXIC REACTIONS TO ANESTHETICS

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

Algorithm of therapeutic measures
1. Give the patient a horizontal position.
2. Fresh air. Let the vapors of ammonia be inhaled.
3. Caffeine 2 ml s.c.
4. Cordiamin 2 ml s.c.
5. In case of respiratory depression - oxygen, artificial respiration (according to indications).
6. Adrenaline 0.1% - 1.0 ml in saline IV.
7. Prednisolone 60-90 mg IV.
8. Tavegil, suprastin, diphenhydramine.
9. Cardiac glycosides (according to indications).

ANGINA

An attack of angina pectoris is a paroxysm of pain or other unpleasant sensations (heaviness, constriction, pressure, burning) in the region of the heart lasting from 2-5 to 30 minutes with characteristic irradiation (to the left shoulder, neck, left shoulder blade, lower jaw), caused by an excess of myocardial consumption in oxygen over its intake.
An attack of angina pectoris provokes an increase in blood pressure, psycho-emotional stress, which always occurs before and during treatment with a dentist.

Algorithm of therapeutic measures
1. Cessation of dental intervention, rest, access to fresh air, free breathing.
2. Nitroglycerin tablets or capsules (bite the capsule) 0.5 mg under the tongue every 5-10 minutes (total 3 mg under BP control).
3. If the attack is stopped, recommendations for outpatient monitoring by a cardiologist. Resumption of dental benefits - to stabilize the condition.
4. If the attack is not stopped: baralgin 5-10 ml or analgin 50% - 2 ml intravenously or intramuscularly.
5. In the absence of effect - call an ambulance and hospitalization.

ACUTE MYOCARDIAL INFARCTION.

Acute myocardial infarction is an ischemic necrosis of the heart muscle, resulting from an acute discrepancy between the need for oxygen in a myocardial region and its delivery through the corresponding coronary artery.
Clinic. The most characteristic clinical symptom is pain, which is more often localized in the region of the heart behind the sternum, less often captures the entire front surface of the chest. Irradiates to the left arm, shoulder, shoulder blade, interscapular space. The pain usually has a wave-like character: it intensifies, then weakens, it lasts from several hours to several days. Objectively noted pale skin, cyanosis of the lips, excessive sweating, decreased blood pressure. In most patients, the heart rhythm is disturbed (tachycardia, extrasystole, atrial fibrillation).

Algorithm of therapeutic measures

1. Urgent termination of intervention, rest, access to fresh air.
2. Calling a cardiological ambulance team.
3. With systolic blood pressure; 100 mm Hg. sublingually 0.5 mg nitroglycerin tablets every 10 minutes (total dose 3 mg).
4. Mandatory relief of pain syndrome: baralgin 5 ml or analgin 50% - 2 ml intravenously or intramuscularly.
5. Inhalation of oxygen through a mask.
6. Papaverine 2% - 2.0 ml / m.
7. Eufillin 2.4% - 10 ml per physical. r-re in / in.
8. Relanium or Seduxen 0.5% - 2 ml
9. Hospitalization.

CLINICAL DEATH

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

Algorithm of therapeutic measures
REANIMATION:
1. Lay on the floor or couch, throw back your head, push your jaw.
2. Clear the airways.
3. Insert an air duct, carry out artificial ventilation of the lungs and external heart massage.
during resuscitation by one person in the ratio: 2 breaths per 15 compressions of the sternum;
with resuscitation together in the ratio: 1 breath for 5 compressions of the sternum .;
Take into account that the frequency of artificial respiration is 12-18 per minute, and the frequency of artificial circulation is 80-100 per minute. Artificial ventilation of the lungs and external heart massage are carried out before the arrival of "resuscitation".
During resuscitation, all drugs are administered only intravenously, intracardiac (adrenaline is preferable - intratracheally). After 5-10 minutes, the injections are repeated.
1. Adrenaline 0.1% - 0.5 ml diluted 5 ml. physical solution or glucose intracardiac (preferably - intertracheally).
2. Lidocaine 2% - 5 ml (1 mg per kg of body weight) IV, intracardiac.
3. Prednisolone 120-150 mg (2-4 mg per kg of body weight) IV, intracardiac.
4. Sodium bicarbonate 4% - 200 ml IV.
5. Ascorbic acid 5% - 3-5 ml IV.
6. Cold to the head.
7. Lasix according to indications 40-80 mg (2-4 ampoules) IV.
Resuscitation is carried out taking into account the existing asystole or fibrillation, which requires electrocardiography data. When diagnosing fibrillation, a defibrillator (if the latter is available) is used, preferably before medical therapy.
In practice, all of these activities are carried out simultaneously.

First aid in emergency situations can save a person's life. Before talking about the types of emergency conditions, an important point should be said, namely the concept of these very conditions. By the name of the definition, it can be seen that emergency conditions are called such, when a patient urgently needs medical care, her expectation cannot be postponed even for a second, because then all this can adversely affect the health, and sometimes the life of a person.

Such conditions are divided into categories, depending on the problem itself.

• Injuries. Injuries include fractures, and burns and damage to blood vessels. In addition, injury is considered damage by electricity, frostbite. Another broad subgroup of injuries is damage to organs that have the status of vital - the brain, heart, lungs, kidneys and liver. Their peculiarity is that they arise most often due to interaction with various objects, that is, under the influence of some circumstance or object.
• Poisoning. Poisoning can be obtained not only through food, respiratory organs and open wounds. Also, poisons can penetrate through the veins and skin. The peculiarity of poisoning is that the damage is not visible to the naked eye. Poisoning occurs inside the body at the cellular level.
• Acute diseases of the internal organs. These include stroke, heart attack, pulmonary edema, peritonitis, acute renal or hepatic failure. Such conditions are extremely dangerous and lead to loss of strength and cessation of the activity of internal organs.
• In addition to the above groups, emergency conditions are bites from poisonous insects, bouts of disease, injuries from catastrophes, etc.

It is difficult to divide all such conditions into groups, the main feature is the threat to life and the urgent intervention of doctors!

Principles of emergency care

To do this, you need to know the rules of first aid and be able to apply them in practice if necessary. Also, the main task of the person who happened to be next to the victim is to remain calm and immediately call for medical help. To do this, always keep the emergency phone number handy or in your cell phone notebook. Do not let the victim harm yourself, try to secure and immobilize him. If you see that the ambulance does not arrive for a long time, take resuscitation actions yourself.

First aid

Algorithm of actions in the provision of first medical aid in emergency conditions

• Epilepsy. This is a seizure in which the patient loses consciousness, makes convulsive movements. Also, he is foaming at the mouth. To help the patient, you need to put him on his side so that his tongue does not sunk, and hold his arms and legs during convulsions. Doctors use chlorpromazine and magnesium sulfate, after which they take the patient to a medical facility.
• Fainting.
• Bleeding.
• Electric shock.
• Poisoning.

Artificial respiration

How to help children

In children, as in adults, there are urgent conditions. But the trouble is that children may not notice something was wrong, and also begin to act up, cry, and adults may simply not believe him. This is a great danger, because timely assistance can save the child's life, and if suddenly his condition worsens, call the doctor immediately. After all, the child's body is not yet strong, and the state of emergency should be urgently eliminated.

• To begin with, calm the child so that he does not cry, does not push, does not kick, and is not afraid of the doctors. Describe to the doctor everything that happened as accurately as possible, more and faster. Tell us what medicines he was given and what he ate, perhaps the child has an allergic reaction.
• Before the doctor arrives, prepare antiseptics, clean clothes and fresh air in a room with a comfortable temperature so that the child breathes well. If you see that the condition is deteriorating rapidly, start resuscitation, cardiac massage, artificial respiration. And also measure the temperature and do not let the child fall asleep until the doctor arrives.
• When the doctor arrives, he will look at the work of the internal organs, the work of the heart and the pulse. In addition, when making a diagnosis, he will definitely ask how the child behaves, his appetite and usual behavior. Have you had any symptoms before. Some parents do not tell the doctor everything, for various reasons, but it is absolutely impossible to do this, because he must have a complete picture of the life and activities of your child, so tell everything as detailed and accurate as possible.

First Aid Standards for Emergencies

• Fainting. It is necessary to tilt your head down and keep it in this position in the fresh air, and also bring a cotton swab with ammonia to the patient. Provide the patient with peace and quiet, as well as eliminate sources of stress.
• Bleeding. In order to prevent the loss of blood in huge quantities, you need to stop it. If this is arterial bleeding, that is, blood is gushing out, it will be more difficult to stop it. A tight bandage or tourniquet is applied, and be sure to write the time of application under it! If this is not done, there is a risk of losing a limb.
• Electric shock. The degree of electric shock can be different, because it depends on the device with which you received the burn and the time of interaction with it. Here, the first step is to remove exactly the source of the lesion, using a wooden stick. Before the arrival of the ambulance, you need to check the necessary indicators of pulse, breathing, consciousness.
• Poisoning. To help a person in case of poisoning, you need to minimize the amount of poison in his body, and remove them. Rinse the stomach and intestines, give a laxative, and call an ambulance immediately!