Introduction

Anaphylactic shock

Arterial hypotension

angina pectoris

myocardial infarction

Bronchial asthma

Coma states

Hepatic coma. Vomiting "Coffee grounds"

convulsions

poisoning

Electric shock

Renal colic

List of sources used

urgent condition (from Latin urgens, urgent) is a condition that poses a threat to the life of the patient / victim and requires urgent (within minutes-hours, not days) medical and evacuation measures.

Primary requirements

1. Readiness to provide emergency medical care in the proper amount.

Complete set of equipment, tools and medicines. Medical personnel must be proficient in the necessary manipulations, be able to work with equipment, know the doses, indications and contraindications for the use of essential medicines. It is necessary to get acquainted with the operation of the equipment and read manuals in advance, and not in an emergency.

2. Simultaneity of diagnostic and therapeutic measures.

For example, a patient with a coma of unknown origin is sequentially injected intravenously with a bolus for therapeutic and diagnostic purposes: thiamine, glucose and naloxone.

Glucose - the initial dose of 80 ml of a 40% solution. If the cause of the coma is a hypoglycemic coma, the patient will regain consciousness. In all other cases, glucose will be absorbed as an energy product.

Thiamine - 100 mg (2 ml of 5% thiamine chloride solution) for the prevention of acute Wernicke's encephalopathy (a potentially fatal complication of alcohol coma).

Naloxone - 0.01 mg/kg in case of opiate poisoning.

3. Orientation primarily to the clinical situation

In most cases, lack of time and insufficient information about the patient do not allow to formulate a nosological diagnosis and treatment is essentially symptomatic and/or syndromic. It is important to keep pre-worked algorithms in mind and be able to pay attention to the most important details necessary for diagnosis and emergency care.

4. Remember about your own safety

The patient may be infected (HIV, hepatitis, tuberculosis, etc.). The place where emergency care is provided is dangerous (poisonous substances, radiation, criminal conflicts, etc.) Misbehavior or errors in the provision of emergency care may be a reason for prosecution.

What are the main causes of anaphylactic shock?

This is a life-threatening acute manifestation of an allergic reaction. It often develops in response to parenteral administration of drugs, such as penicillin, sulfonamides, serums, vaccines, protein preparations, radiopaque substances, etc., and also appears during provocative tests with pollen and less often food allergens. Anaphylactic shock may occur with insect bites.

The clinical picture of anaphylactic shock is characterized by the speed of development - a few seconds or minutes after contact with the allergen. There is depression of consciousness, a drop in blood pressure, convulsions, involuntary urination appear. The lightning-fast course of anaphylactic shock ends in death. For most, the disease begins with the appearance of a feeling of heat, flushing of the skin, fear of death, arousal, or, conversely, depression, headache, chest pain, and suffocation. Sometimes laryngeal edema develops according to the type of Quincke's edema with stridor breathing, skin itching, rashes, rhinorrhea, dry hacking cough appear. Blood pressure drops sharply, the pulse becomes thready, hemorrhagic syndrome with petechial rashes can be expressed.

How to provide emergency care to the patient?

It is necessary to stop the introduction of drugs or other allergens, apply a tourniquet proximal to the injection site of the allergen. Assistance must be provided locally; for this purpose, it is necessary to lay the patient down and fix the tongue to prevent asphyxia. Inject 0.5 ml of 0.1% adrenaline solution subcutaneously at the site of allergen injection (or at the bite site) and intravenously drip 1 ml of 0.1% adrenaline solution. If blood pressure remains low, after 10-15 minutes, the administration of the adrenaline solution should be repeated. Corticosteroids are of great importance for removing patients from anaphylactic shock. Prednisolone should be injected into a vein at a dose of 75-150 mg or more; dexamethasone - 4-20 mg; hydrocortisone - 150-300 mg; if it is impossible to inject corticosteroids into a vein, they can be administered intramuscularly. Introduce antihistamines: pipolfen - 2-4 ml of a 2.5% solution subcutaneously, suprastin - 2-4 ml of a 2% solution or diphenhydramine - 5 ml of a 1% solution. In case of asphyxia and suffocation, inject 10-20 ml of a 2.4% solution of aminophylline intravenously, alupent - 1-2 ml of a 0.05% solution, isadrin - 2 ml of a 0.5% solution subcutaneously. If signs of heart failure appear, introduce corglicon - 1 ml of a 0.06% solution in an isotonic sodium chloride solution, lasix (furosemide) 40-60 mg intravenously rapidly in an isotonic sodium chloride solution. If an allergic reaction has developed to the administration of penicillin, inject 1,000,000 IU of penicillinase in 2 ml of isotonic sodium chloride solution. The introduction of sodium bicarbonate (200 ml of a 4% solution) and antishock liquids is shown. If necessary, resuscitation is carried out, including closed heart massage, artificial respiration, bronchial intubation. With swelling of the larynx, a tracheostomy is indicated.

What are the clinical manifestations of arterial hypotension?

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

2 ml of a 20% solution of caffeine or 1 ml of a 5% solution of ephedrine is administered. Hospitalization is not required.

What is characteristic of pain in the heart caused by angina pectoris?

The most important point in the treatment of angina pectoris is the relief of pain attacks. Pain in angina pectoris is characterized by compressive pain in the chest, which can occur either after exercise (angina pectoris) or at rest (angina pectoris). The pain lasts for several minutes and is relieved by taking nitroglycerin.

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

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

An analgesic effect is given by intramuscular injection of 2 ml of a 50% solution of analgin. Sometimes its use allows you to reduce the dose of administered narcotic analgesics, since analgin enhances their effect. Sometimes a good analgesic effect is given by the use of mustard plasters on the heart area. Irritation of the skin in this case causes a reflex expansion of the coronary arteries and improves blood supply to the myocardium.

What are the main causes of myocardial infarction?

Myocardial infarction - necrosis of a section of the heart muscle, which develops as a result of a violation of its blood supply. The immediate cause of myocardial infarction is the closure of the lumen of the coronary arteries or the narrowing of an atherosclerotic plaque or thrombus.

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

Emergency care in the acute stage of a heart attack includes, first of all, the removal of a painful attack. If a preliminary repeated intake of nitroglycerin (0.0005 g per tablet or 2-3 drops of a 1% alcohol solution) did not relieve the pain, it is necessary to enter promedol (1 ml of a 2% solution), pantopon (1 ml of a 2% solution) or morphine (1 cl 1% solution) subcutaneously together with 0.5 ml of a 0.1% solution of atropine and 2 ml of cordiamine. If subcutaneous administration of narcotic analgesics did not have an analgesic effect, one should resort to intravenous infusion of 1 ml of morphine with 20 ml of 40% glucose solution. Sometimes anginal pain can be removed only with the help of anesthesia with nitrous oxide mixed with oxygen in a ratio of 4:1, and after the cessation of pain - 1:1. In recent years, fentanyl, 2 ml of a 0.005% solution intravenously with 20 ml of saline, has been used to relieve pain and prevent shock. Together with fentanyl, 2 ml of a 0.25% solution of droperidol is usually administered; this combination allows you to enhance the analgesic effect of fentanyl and make it last longer. The use of fentanyl shortly after the administration of morphine is undesirable due to the risk of respiratory arrest.

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

What is the general characteristic of an asthma attack?

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

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

What are the manifestations and causes of collapse?

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

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

The severity of symptoms depends on the nature of the underlying disease. So with acute blood loss, the pallor of the skin and visible mucous membranes is striking; with myocardial infarction, cyanosis of the skin of the face, acrocyanosis, etc. can often be noted.

When the patient collapses, it is necessary to give a horizontal position (remove pillows from under the head), put heating pads on the limbs. Call a doctor immediately. Prior to his arrival, it is necessary to introduce the patient with cardiovascular agents (cordiamin, caffeine) subcutaneously. As prescribed by the doctor, a set of measures is carried out depending on the cause of the collapse: hemostatic therapy and blood transfusion for blood loss, the introduction of cardiac glycosides and painkillers for myocardial infarction, etc.

What is a coma?

A coma is an unconscious state with a profound impairment of reflexes, a lack of response to stimuli.

A common and main symptom of a coma of any origin is a deep loss of consciousness due to damage to the vital parts of the brain.

A coma may arise suddenly in the midst of relative well-being. Acute development is typical for cerebral coma in stroke, hypoglycemic coma. However, in many cases, a coma that complicates the course of the disease develops gradually (with diabetic, uremic, hepatic coma and many other coma). In these cases, a coma, a deep loss of consciousness, is preceded by a precoma stage. Against the background of the growing exacerbation of the symptoms of the underlying disease, signs of damage to the central nervous system appear in the form of stupor, lethargy, indifference, confusion with periodic clarifications. However, during this period, patients retain the ability to respond to strong irritations, late, in monosyllables, but still answer a loudly asked question, they retain pupillary, corneal and swallowing reflexes. Knowing the symptoms of a precoma is especially important, since timely assistance during this period of the disease often prevents the development of coma and saves the life of patients.

Hepatic coma. Vomiting "Coffee grounds"

When examining the skin, it should be borne in mind that with uremia, cerebral thrombosis, anemia, the skin is pale. With an alcoholic coma, cerebral hemorrhage, the face is usually hyperemic. Pink coloration of the skin is characteristic of coma due to carbon monoxide poisoning. Yellowness of the skin is usually observed in hepatic coma. It is important to determine the moisture content of the patient's skin in a coma. Wet, sweaty skin is characteristic of hypoglycemic coma. In a diabetic coma, the skin is always dry. Traces of old scratches on the skin can be noted in patients with diabetic, hepatic and uremic coma. Fresh boils, as well as skin scars from old boils found in patients in a coma, suggest diabetes mellitus.

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

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

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

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

In case of hepatic coma, glucose solutions, steroid hormones, and vitamins are administered as a drop of glucose solutions.

What is the pathogenesis and main causes of syncope?

Fainting is a sudden short-term loss of consciousness with a weakening of the activity of the cardiac and respiratory systems. Fainting is a mild form of acute cerebrovascular insufficiency and is caused by anemia of the brain; occurs more often in women. Fainting can occur as a result of mental trauma, at the sight of blood, pain irritation, with prolonged stay in a stuffy room, with intoxication and infectious diseases.

The severity of fainting may be different. Usually, fainting is characterized by a sudden onset of mild clouding of consciousness in combination with non-systemic dizziness, ringing in the ears, nausea, yawning, and increased intestinal motility. Objectively, there is a sharp pallor of the skin, coldness of the hands and feet, drops of sweat on the face, dilated pupils. Pulse of weak filling, arterial pressure is lowered. The attack lasts a few seconds.

In a more severe case of fainting, a complete loss of consciousness occurs with the exclusion of muscle tone, the patient slowly sinks. At the height of fainting, there are no deep reflexes, the pulse is barely palpable, blood pressure is low, breathing is shallow. The attack lasts several tens of seconds, and then follows a quick and complete recovery of consciousness without the effects of amnesia.

Convulsive fainting is characterized by the addition of convulsions to the picture of fainting. In rare cases, salivation, involuntary urination and defecation are noted. Unconsciousness sometimes lasts for several minutes.

After fainting, general weakness, nausea, and an unpleasant sensation in the abdomen persist.

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

The patient should be examined by a doctor.

What are the hallmarks of a seizure in epilepsy?

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

When providing first aid to the patient, first of all, it is necessary to prevent possible bruises of the head, arms, legs during a fall and convulsions, for which a pillow is placed under the patient's head, arms and legs are held. To prevent asphyxia, it is necessary to unfasten the collar. Between the patient's teeth, you need to insert a solid object, such as a spoon wrapped in a napkin, in order to prevent biting the tongue. To avoid inhalation of saliva, the patient's head should be turned to the side.

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

In status epilepticus, emergency care consists in prescribing an enema with chloral hydrate (2.0 g per 50 ml of water), intravenous administration of 10 ml of a 25% magnesium sulfate solution and 10 ml of a 40% glucose solution, intramuscular injection of 2-3 ml of a 2.5% solution chlorpromazine, intravenous infusion of 20 mg of diazepam (seduxen) dissolved in 10 ml of 40% glucose solution. With ongoing seizures, 5-10 ml of a 10% solution of hexenal is slowly injected intravenously. Do spinal puncture with the removal of 10-15 ml of solution.

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

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

What is the general characteristic of poisoning?

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

For all acute poisoning, emergency care should pursue the following goals: 1) the fastest removal of the poison from the body; 2) neutralization of the poison remaining in the body with the help of antidotes (antidotes); 3) the fight against respiratory and circulatory disorders.

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

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

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

Electric shock above 50 V causes thermal and electrolytic effects. Most often, the defeat occurs due to non-compliance with safety precautions when working with electrical appliances, both at home and at work.

First of all, the victim is released from contact with electric current (if this has not been done before). Turn off the power supply, and if this is not possible, then discard the broken wire with a dry wooden stick. If the person providing assistance is dressed in rubber boots and rubber gloves, then you can drag the victim away from the electrical wire. When breathing stops, artificial respiration is carried out, cardiac and cardiovascular agents are administered (0.1% adrenaline solution - 1 ml, cordiamine - 2 ml, 10% caffeine solution - 1 ml subcutaneously), respiratory stimulants (1% lobelin solution - 1 ml intravenously slowly or intramuscularly). Sterile dressing is applied to the electrical burn wound.

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

What are the causes of renal colic?

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

The attack starts suddenly. Most often it is caused by physical exertion, but it can also occur in the middle of complete rest, at night during sleep, often after heavy drinking. The pain is cutting with periods of calm and exacerbation. Patients are restless, tossing about in bed in search of a position that would alleviate their suffering. An attack of renal colic often takes a protracted character and with short remissions can last several days in a row. As a rule, the pain begins in the lumbar region and spreads to the hypochondrium and abdomen and, which is especially characteristic, along the ureter towards the bladder, scrotum in men, labia in women, to the thighs. In many cases, the intensity of pain is greater in the abdomen or at the level of the genitals than in the kidney area. The pain is usually accompanied by increased urge to urinate and cutting pain in the urethra.

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

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

1. Evdokimov N.M. Provision of first medical aid.-M., 2001

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

3. First aid: reference book M., 2001

Fainting is a sudden, short-term loss of consciousness due to impaired blood circulation in the brain.

Fainting can last from a few seconds to several minutes. Usually a person comes to his senses after a while. Fainting in itself is not a disease, but rather a symptom of a disease.

Fainting can be due to various reasons:

1. Sudden sharp pain, fear, nervous shocks.

They can cause an instant decrease in blood pressure, resulting in a decrease in blood flow, a violation of the blood supply to the brain, which leads to fainting.

2. General weakness of the body, sometimes aggravated by nervous exhaustion.

General weakness of the body, due to a variety of reasons, ranging from hunger, poor nutrition, and ending with constant excitement, can also lead to low blood pressure and fainting.

3. Staying in a room with insufficient oxygen.

Oxygen levels can be reduced due to the presence of a large number of people in the room, poor ventilation and air pollution from tobacco smoke. As a result, the brain receives less oxygen than it needs, and the victim faints.

4. Long stay in a standing position without movement.

This leads to stagnation of blood in the legs, a decrease in its flow to the brain and, as a result, to fainting.

Symptoms and signs of fainting:

The reaction is a short-term loss of consciousness, the victim falls. In a horizontal position, the blood supply to the brain improves and after a while the victim regains consciousness.

Breathing is rare, superficial. Blood circulation - the pulse is weak and rare.

Other signs are dizziness, tinnitus, severe weakness, veil before the eyes, cold sweat, nausea, numbness of the extremities.

First aid for fainting

1. If the airways are free, the victim is breathing and his pulse is felt (weak and rare), he must be laid on his back and his legs raised.

2. Loosen tight clothing, such as collars and waistbands.

3. Put a wet towel on the victim's forehead, or wet his face with cold water. This will lead to vasoconstriction and improve the blood supply to the brain.

4. When vomiting, the victim must be transferred to a safe position, or at least turn his head to the side so that he does not choke on vomit.

5 It must be remembered that fainting can be a manifestation of a severe, including an acute illness that requires emergency care. Therefore, the victim always needs to be examined by his doctor.

6. Do not rush to lift the victim after consciousness has returned to him. If conditions allow, the victim can be given hot tea to drink, and then help to rise and sit down. If the victim again feels faint, he must be laid on his back and raise his legs.

7. If the victim is unconscious for several minutes, most likely it is not fainting and qualified medical assistance is needed.

Shock is a condition that threatens the life of the victim and is characterized by insufficient blood supply to tissues and internal organs.

The blood supply to tissues and internal organs can be disrupted for two reasons:

Heart problems;

Decrease in the volume of fluid circulating in the body (heavy bleeding, vomiting, diarrhea, etc.).

Symptoms and signs of shock:

Reaction - the victim is usually conscious. However, the condition can worsen very quickly, up to loss of consciousness. This is due to a decrease in blood supply to the brain.

The airways are usually free. If there is internal bleeding, there may be a problem.

Breathing - frequent, superficial. Such breathing is explained by the fact that the body is trying to get as much oxygen as possible with a limited amount of blood.

Blood circulation - the pulse is weak and frequent. The heart tries to compensate for the decrease in circulating blood volume by speeding up the circulation. A decrease in blood volume leads to a drop in blood pressure.

Other signs are that the skin is pale, especially around the lips and earlobes, cool and clammy. This is because the blood vessels in the skin close to direct blood to vital organs such as the brain, kidneys, etc. The sweat glands also increase activity. The victim may feel thirsty, due to the fact that the brain feels a lack of fluid. Muscle weakness occurs due to the fact that blood from the muscles goes to the internal organs. There may be nausea, vomiting, chills. Chill means lack of oxygen.

First aid for shock

1. If the shock is caused by impaired blood circulation, then first of all you need to take care of the brain - to ensure the supply of oxygen to it. To do this, if damage allows, the victim must be laid on his back, his legs raised and the bleeding stopped as soon as possible.

If the victim has a head injury, then the legs cannot be raised.

The victim must be laid on his back, putting something under his head.

2. If the shock is caused by burns, then first of all it is necessary to ensure the termination of the effect of the damaging factor.

Then cool the affected area of ​​the body, if necessary, lay the victim with raised legs and cover with something to keep warm.

3. If the shock is caused by a violation of cardiac activity, the victim must be given a semi-sitting position, placing pillows or folded clothes under his head and shoulders, as well as under his knees.

Laying the victim on his back is impractical, since in this case it will be more difficult for him to breathe. Have the victim chew an aspirin tablet.

In all these cases, it is necessary to call an ambulance and, before its arrival, monitor the condition of the victim, being ready to start cardiopulmonary resuscitation.

When assisting a victim in shock, it is unacceptable:

Move the victim, except when necessary;

Give the victim food, drink, smoke;

Leave the victim alone, except in cases where it is necessary to leave to call an ambulance;

Warm the victim with a heating pad or some other source of heat.

ANAPHYLACTIC SHOCK

Anaphylactic shock is an extensive allergic reaction of an immediate type that occurs when an allergen enters the body (insect bites, drug or food allergens).

Anaphylactic shock usually develops within seconds and is an emergency that requires immediate attention.

If anaphylactic shock is accompanied by loss of consciousness, immediate hospitalization is necessary, since the victim in this case may die within 5-30 minutes with asphyxia or after 24-48 hours or more due to severe irreversible changes in vital organs.

Sometimes a fatal outcome can occur later due to changes in the kidneys, gastrointestinal tract, heart, brain and other organs.

Symptoms and signs of anaphylactic shock:

Reaction - the victim feels anxiety, a feeling of fear, as shock develops, loss of consciousness is possible.

Airways - Swelling of the airways occurs.

Respiration - similar to asthmatic. Shortness of breath, chest tightness, cough, intermittent, difficult, may stop altogether.

Blood circulation - the pulse is weak, rapid, may not be palpable on the radial artery.

Other signs - the chest is tense, swelling of the face and neck, swelling around the eyes, redness of the skin, rash, red spots on the face.

First aid for anaphylactic shock

1. If the victim is conscious, give him a semi-sitting position to facilitate breathing. It is better to put him on the floor, unbutton the collar and loosen other pressing parts of the clothing.

2. Call an ambulance.

3. If the victim is unconscious, move him to a safe position, control breathing and blood circulation and be ready to proceed with cardiopulmonary resuscitation.

ATTACK OF BRONCHIAL ASTHMA

Bronchial asthma is an allergic disease, the main manifestation of which is an asthma attack caused by impaired bronchial patency.

An attack of bronchial asthma is caused by various allergens (pollen and other substances of plant and animal origin, industrial products, etc.)

Bronchial asthma is expressed in attacks of suffocation, experienced as a painful lack of air, although in reality it is based on difficulty exhaling. The reason for this is the inflammatory narrowing of the airways caused by allergens.

Symptoms and signs of bronchial asthma:

Reaction - the victim may be alarmed, in severe attacks he cannot utter a few words in a row, he may lose consciousness.

Airways - may be narrowed.

Breathing - characterized by obstructed elongated exhalation with many wheezing wheezes, often heard at a distance. Shortness of breath, cough, initially dry, and in the end - with the separation of viscous sputum.

Blood circulation - at first the pulse is normal, then it becomes rapid. At the end of a prolonged attack, the pulse may become thready until the heart stops.

Other signs are anxiety, extreme fatigue, sweating, tension in the chest, talking in a whisper, blue skin, nasolabial triangle.

First aid for an attack of bronchial asthma

1. Remove the victim to fresh air, unfasten the collar and loosen the belt. Sit with an inclination forward and with an emphasis on the chest. In this position, the airways open.

2. If the victim has any medications, help them use them.

3. Call an ambulance immediately if:

This is the first attack;

The attack did not stop after taking the medicine;

The victim has too difficult breathing and it is difficult for him to speak;

The victim is showing signs of extreme exhaustion.

HYPERVENTILATION

Hyperventilation is an excess of pulmonary ventilation relative to the level of metabolism, due to deep and (or) frequent breathing and leading to a decrease in carbon dioxide and an increase in oxygen in the blood.

The cause of hyperventilation is most often panic or serious excitement caused by fear or any other reasons.

Feeling strong excitement or panic, a person begins to breathe more often, which leads to a sharp decrease in the carbon dioxide content in the blood. Hyperventilation sets in. The victim begins in connection with this to feel even more anxiety, which leads to increased hyperventilation.

Symptoms and signs of hyperventilation:

Reaction - the victim is usually alarmed, feels confused. Airways - open, free.

Breathing is naturally deep and frequent. As hyperventilation develops, the victim breathes more and more often, but subjectively feels suffocation.

Blood circulation - does not help to recognize the cause.

Other signs - the victim feels dizzy, sore throat, tingling in the arms, legs or mouth, the heartbeat may increase. Looking for attention, help, can become hysterical, faint.

First aid for hyperventilation.

1. Bring a paper bag to the nose and mouth of the victim and ask him to breathe the air that he exhales into this bag. In this case, the victim exhales air saturated with carbon dioxide into the bag, and inhales it again.

Usually after 3-5 minutes, the level of saturation of the blood with carbon dioxide returns to normal. The respiratory center in the brain receives relevant information about this and gives a signal: to breathe more slowly and deeply. Soon the muscles of the respiratory organs relax, and the entire respiratory process returns to normal.

2. If the cause of hyperventilation was emotional arousal, it is necessary to calm the victim, restore his sense of confidence, persuade the victim to sit down and relax calmly.

ANGINA

Angina pectoris (angina pectoris) - an attack of acute pain behind the sternum, due to transient insufficiency of the coronary circulation, acute myocardial ischemia.

The cause of an attack of angina pectoris is insufficient blood supply to the heart muscle, caused by coronary insufficiency due to narrowing of the lumen of the coronary (coronary) artery of the heart with atherosclerosis, vascular spasm, or a combination of these factors.

Angina pectoris can occur due to psycho-emotional stress, which can lead to spasm of pathologically unchanged coronary arteries of the heart.

However, most often, angina pectoris still occurs when the coronary arteries narrow, which can be 50-70% of the lumen of the vessel.

Symptoms and signs of angina pectoris:

Reaction - the victim is conscious.

The airways are free.

Breathing - superficial, the victim does not have enough air.

Blood circulation - the pulse is weak and frequent.

Other signs - the main symptom of pain syndrome - its paroxysmal. Pain has a fairly clear beginning and end. By nature, the pain is compressive, pressing, sometimes in the form of a burning sensation. As a rule, it is localized behind the sternum. Characterized by irradiation of pain in the left half of the chest, in the left hand to the fingers, left shoulder blade and shoulder, neck, lower jaw.

The duration of pain in angina pectoris, as a rule, does not exceed 10-15 minutes. Usually they occur at the time of physical exertion, most often when walking, and also during stress.

First aid for angina pectoris.

1. If the attack has developed during physical exertion, it is necessary to stop the load, for example, stop.

2. Give the victim a semi-sitting position, placing pillows or folded clothing under his head and shoulders, as well as under his knees.

3. If the victim has previously had angina attacks, for the relief of which he used nitroglycerin, he can take it. For faster absorption, a nitroglycerin tablet must be placed under the tongue.

The victim should be warned that after taking nitroglycerin, there may be a feeling of fullness in the head and headache, sometimes dizziness, and, if you stand, fainting. Therefore, the victim should remain in a semi-sitting position for some time even after the pain has passed.

In the case of the effectiveness of nitroglycerin, an angina attack disappears after 2-3 minutes.

If after a few minutes after taking the drug the pain has not disappeared, you can take it again.

If, after taking the third tablet, the pain does not go away in the victim and drags on for more than 10-20 minutes, an ambulance should be urgently called, since a heart attack is likely to develop.

HEART ATTACK (MYOCARDIAL INFARCTION)

Heart attack (myocardial infarction) - necrosis (necrosis) of a section of the heart muscle due to a violation of its blood supply, manifested in a violation of cardiac activity.

A heart attack occurs due to blockage of a coronary artery by a thrombus - a blood clot that forms at the site of a narrowing of the vessel during atherosclerosis. As a result, a more or less extensive area of ​​the heart is “turned off”, depending on which part of the myocardium was supplied with blood by the clogged vessel. A thrombus cuts off the supply of oxygen to the heart muscle, resulting in necrosis.

Causes of a heart attack can be:

Atherosclerosis;

Hypertonic disease;

Physical activity in combination with emotional stress - vasospasm during stress;

Diabetes mellitus and other metabolic diseases;

genetic predisposition;

Environmental influence, etc.

Symptoms and signs of a heart attack (heart attack):

Reaction - in the initial period of a painful attack, restless behavior, often accompanied by a fear of death, in the future, loss of consciousness is possible.

The airways are usually free.

Breathing - frequent, shallow, may stop. In some cases, asthma attacks are observed.

Blood circulation - the pulse is weak, fast, may be intermittent. Possible cardiac arrest.

Other signs are severe pain in the region of the heart, usually occurring suddenly, more often behind the sternum or to the left of it. The nature of the pain is compressive, pressing, burning. Usually it radiates to the left shoulder, arm, shoulder blade. Often with a heart attack, unlike angina pectoris, pain spreads to the right of the sternum, sometimes captures the epigastric region and "gives" to both shoulder blades. The pain is growing. The duration of a painful attack during a heart attack is calculated in tens of minutes, hours, and sometimes days. There may be nausea and vomiting, the face and lips may turn blue, severe sweating. The victim may lose the ability to speak.

First aid for a heart attack.

1. If the victim is conscious, give him a half-sitting position, placing pillows or folded clothes under his head and shoulders, as well as under his knees.

2. Give the victim an aspirin tablet and ask him to chew it.

3. Loosen the squeezing parts of the clothing, especially at the neck.

4. Immediately call an ambulance.

5. If the victim is unconscious but breathing, put him in a safe position.

6. Control breathing and blood circulation, in case of cardiac arrest, immediately begin cardiopulmonary resuscitation.

A stroke is an acute circulatory disorder in the brain or spinal cord caused by a pathological process with the development of persistent symptoms of damage to the central nervous system.

The cause of a stroke can be a hemorrhage in the brain, cessation or weakening of the blood supply to any part of the brain, blockage of the vessel by a thrombus or embolus (a thrombus is a dense blood clot in the lumen of a blood vessel or heart cavity, formed in vivo; an embolus is a substrate circulating in the blood, not normally occurring and capable of causing blockage of blood vessels).

Strokes are more common in the elderly, although they can occur at any age. More commonly seen in men than in women. About 50% of those affected by a stroke die. Of those who survive, about 50% become crippled and have another stroke weeks, months, or years later. However, many stroke survivors regain their health through rehabilitation measures.

Symptoms and signs of a stroke:

The reaction is confused consciousness, there may be a loss of consciousness.

The airways are free.

Breathing - slow, deep, noisy, wheezing.

Blood circulation - the pulse is rare, strong, with good filling.

Other signs are a severe headache, the face may turn red, become dry, hot, speech disturbances or slowdowns may be observed, the corner of the lips may sag even if the victim is conscious. The pupil on the affected side may be dilated.

With a slight lesion, weakness, with a significant one, complete paralysis.

First aid for stroke

1. Call for qualified medical assistance immediately.

2. If the victim is unconscious, check if the airways are open, restore airway patency if it is broken. If the victim is unconscious, but breathing, move him to a safe position on the side of the injury (to the side where the pupil is dilated). In this case, the weakened or paralyzed part of the body will remain at the top.

3. Be prepared for rapid deterioration and CPR.

4. If the victim is conscious, lay him on his back with something under his head.

5. The victim may have a micro-stroke, in which there is a slight speech disorder, slight clouding of consciousness, slight dizziness, muscle weakness.

In this case, when providing first aid, you should try to protect the victim from falling, calm and support him and immediately call an ambulance. To control DP - D - K and be ready to provide emergency assistance.

epileptic seizure

Epilepsy is a chronic disease caused by damage to the brain, manifested by repeated convulsive or other seizures and is accompanied by a variety of personality changes.

An epileptic seizure is caused by excessively intense excitation of the brain, which is due to an imbalance in the human bioelectrical system. Typically, a group of cells in one part of the brain loses electrical stability. This creates a strong electrical discharge that rapidly spreads to the surrounding cells, disrupting their normal functioning.

Electrical phenomena can affect the entire brain or only part of it. Accordingly, there are major and minor epileptic seizures.

A minor epileptic seizure is a short-term disturbance of brain activity, leading to a temporary loss of consciousness.

Symptoms and signs of a small epileptic seizure:

The reaction is a temporary loss of consciousness (from a few seconds to a minute). The airways are open.

Breathing is normal.

Blood circulation - pulse normal.

Other signs are an unseeing gaze, repetitive or twitching movements of individual muscles (head, lips, arms, etc.).

A person comes out of such a seizure as suddenly as he enters it, and he continues the interrupted actions, not realizing that a seizure has occurred to him.

First aid for a small epileptic seizure

1. Eliminate the danger, seat the victim and calm him down.

2. When the victim wakes up, tell him about the seizure, as this may be his first seizure and the victim does not know about the disease.

3. If this is your first seizure, see your doctor.

A grand mal seizure is a sudden loss of consciousness accompanied by severe convulsions (convulsions) of the body and limbs.

Symptoms and signs of a grand mal seizure:

Reaction - begins with sensations close to euphoric (unusual taste, smell, sound), then loss of consciousness.

The airways are free.

Breathing - may stop, but recovers quickly. Blood circulation - pulse normal.

Other signs - usually the victim falls to the floor without consciousness, he begins to have sharp convulsive movements of the head, arms and legs. There may be a loss of control over physiological functions. The tongue is bitten, the face turns pale, then becomes bluish. The pupils do not react to light. Foam may come out of the mouth. The total duration of the seizure ranges from 20 seconds to 2 minutes.

First aid for a major epileptic seizure

1. Noticing that someone is on the verge of a seizure, you must try to make sure that the victim does not harm himself when falling.

2. Make room around the victim and put something soft under his head.

3. Loosen clothing around the victim's neck and chest.

4. Do not try to restrain the victim. If his teeth are clenched, do not try to open his jaws. Do not try to put something into the victim's mouth, as this can lead to trauma to the teeth and block the airways with their fragments.

5. After the cessation of convulsions, transfer the victim to a safe position.

6. Treat all injuries sustained by the victim during the seizure.

7. After the seizure has stopped, the victim must be hospitalized if:

The attack happened for the first time;

There was a series of seizures;

There are damages;

The victim was unconscious for more than 10 minutes.

HYPOGLYCEMIA

Hypoglycemia - low blood glucose Hypoglycemia can occur in a diabetic patient.

Diabetes is a disease in which the body does not produce enough of the hormone insulin, which regulates the amount of sugar in the blood.

If the brain does not receive enough sugar, then, just as with a lack of oxygen, brain functions are impaired.

Hypoglycemia can occur in a diabetic patient for three reasons:

1) the victim injected insulin, but did not eat on time;

2) with excessive or prolonged physical activity;

3) with an overdose of insulin.

Symptoms and signs of hypoglycemia:

The reaction is confused consciousness, loss of consciousness is possible.

Respiratory tract - clean, free. Breathing - rapid, superficial. Blood circulation - a rare pulse.

Other signs are weakness, drowsiness, dizziness. Feeling of hunger, fear, pallor of the skin, profuse sweat. Visual and auditory hallucinations, muscle tension, trembling, convulsions.

First aid for hypoglycemia

1. If the victim is conscious, give him a relaxed position (lying or sitting).

2. Give the victim a sugar drink (two tablespoons of sugar in a glass of water), a sugar cube, chocolate or sweets, caramel or cookies. The sweetener doesn't help.

3. Provide rest until the condition is completely normal.

4. If the victim has lost consciousness, transfer him to a safe position, call an ambulance and monitor the condition, be ready to proceed with cardiopulmonary resuscitation.

POISONING

Poisoning - intoxication of the body caused by the action of substances entering it from the outside.

Poisonous substances can enter the body in various ways. There are different classifications of poisoning. So, for example, poisoning can be classified according to the conditions for the entry of toxic substances into the body:

During a meal;

Through the respiratory tract;

through the skin;

When bitten by an animal, insect, snake, etc.;

through mucous membranes.

Poisoning can be classified according to the type of poisoning:

food poisoning;

medicinal poisoning;

Alcohol poisoning;

Chemical poisoning;

gas poisoning;

Poisoning caused by bites of insects, snakes, animals.

The task of first aid is to prevent further exposure to the poison, to accelerate its removal from the body, to neutralize the remains of the poison and to support the activity of the affected organs and body systems.

To solve this problem, you need:

1. Take care of yourself so as not to get poisoned, otherwise you will need help yourself, and the victim will have no one to help.

2. Check the reaction, respiratory tract, breathing and blood circulation of the victim, if necessary, take appropriate measures.

5. Call an ambulance.

4. If possible, set the type of poison. If the victim is conscious, ask him about what happened. If unconscious - try to find witnesses of the incident, or packaging from toxic substances or some other signs.

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 institution.

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 functioning 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 squeeze 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 returned to normal.

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.

Providing first aid requires a special approach from the medical staff. Algorithms for helping patients with common symptoms are available for download.

Quality first aid for emergencies (ES) is vital. Each condition and disease requires a special approach from the medical staff.

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

↯ More articles in the journal

The main thing in the material

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

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

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

In all such emergency situations, the task of physicians is to prevent the deterioration of the patient's condition. This will improve the patient's condition.

The Ministry of Health has prepared amendments to the procedure for primary care for adults. Learn how to implement requirements without delay in the magazine "Deputy Chief Physician"

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

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

According to these and other signs, it can be understood that a person needs emergency assistance in case of emergency.

What is important to consider:

Help with NS has several important tasks:

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

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

Help with various conditions and diseases

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

Let's look at a few examples.

1. With dehydration (dehydration), the first actions of physicians include:
   • intravenous administration of a special solution in an amount equal to 10% of the patient's weight (trisol, quartasol, sodium chlorine solution, etc.);
   • the rate of injection of the solution is observed. The first 2 liters - at a rate of up to 120 ml per minute, then - at a rate of 30-60 ml per minute;
   • preferably the introduction of a solution of quartasol.
2. In case of infectious-toxic shock, the first medical aid for emergency conditions includes:
   • carrying out oxygen inhalation;
   • staging prednisolone 60 mg with a solution of sodium chloride;
   • trental is administered intravenously or drip;
   • if these drugs are not available, 400 ml of gemodez, saline and glucose, etc. are injected intravenously.
   • further with it doctors of a hospital are engaged.
3. In acute neurological syndrome, emergency care includes:
   • placing it in the most functionally advantageous position;
   • psychomotor agitation is removed, for which the patient is given diazepam, sodium oxybutyrate, prednisolone, oxygen inhalation, etc.;
   • in the presence of hyperthermia - amidopyrine, reopyrin, etc.;
   • further care includes general and local physical hypothermia.

Approved new rules for the organization of palliative care. In the article of the magazine "Deputy Chief Physician" read how the duties of the medical staff were divided, what information and medical devices now need to be provided to relatives and how to refer patients to social services. In the application - ready-made documents to organize the work.

How to provide first aid for anaphylactic shock

In emergencies that develop rapidly, first aid is vital. For example, with anaphylactic shock, doctors have a few minutes at their disposal.

9 steps emergency medical care:

1. The entry of the alleged allergen into the human body must be stopped immediately. If this is a drug, its administration should be stopped immediately, and ice should be applied to the injection site.
2. The physician evaluates the general condition, the type of skin, breathing and blood circulation of the patient, the patency of the respiratory tract.

An ambulance is immediately called, and if the patient is in the hospital, the resuscitation team.

1. Epinephrine (adrenaline) is injected intramuscularly into the middle of the anterolateral surface of the thigh in a dosage corresponding to the age and weight of the person. Most patients respond to the first dose of adrenaline, if this does not happen, the procedure is repeated after 5-15 minutes.
2. Having laid the patient on his back, he should raise his legs and turn his head to the side so as to prevent the tongue from falling and asphyxia. If the patient has dentures, they must be removed.

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

1. If there is difficulty in breathing, a triple intake according to P. Safar is performed, an endotracheal tube is inserted.

If there is swelling of the larynx or pharynx, it is necessary to intubate the trachea. In severe cases, a conicotomy is performed.

1. After normalization of breathing, an influx of fresh air into the room is organized. If this is not possible, pure oxygen is used.
2. Intravenous access should be established. According to the doctor's prescription, a solution of sodium chloride is introduced. Doctors must be prepared to conduct emergency resuscitation.

Help with NS also includes chest compressions according to indications.

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

In the folder of the head

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

Help with OOI

A particularly dangerous infection requires a special approach to first aid.

If disinfectants enter the body

• if chloractive preparations, for example, disinfectants, have entered the patient's stomach, immediate gastric lavage with a 2% hyposulfite solution is necessary;
• in case of formaldehyde poisoning, a 3% solution of acetate or sodium carbonate is added to the washing water;
• if the disinfectant gets into the eyes, it is necessary to rinse them with a 2% solution of baking soda or running water for 3-7 minutes;
• in the presence of irritation, a solution of sodium sulfacyl 30% is instilled into the eyes;
• if disinfectants come into contact with the skin, the affected area of ​​\u200b\u200bthe skin is washed with water. Then it is lubricated with a softening ointment;
• if disinfectants have passed through the respiratory tract, the victim is taken to fresh air or to a well-conditioned room. The nasopharynx and mouth are washed with water;
• if these actions did not have a positive effect and the victim became worse, he is placed in a hospital for further diagnosis.

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

Below are algorithms for providing assistance for various diseases and conditions in the form of a memo for download.

The first aid provided must be correct and timely. Our memos reflect the key points that are worth paying attention to.

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

1. Wounds: emergency care depending on the type and location

First aid tasks

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

In the memos, briefly - the tasks of health workers, their primary actions, the necessary medicines and techniques.

Clinical manifestations

First aid

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

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

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

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

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

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

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

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

With a convulsive form of a crisis:

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

2) antihypertensive drugs and diuretics - according to indications.

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

Notes

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

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

angina pectoris

Clinical manifestations s - m. Nursing in therapy.

First aid

1) stop physical activity;

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

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

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

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

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

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

myocardial infarction

Clinical manifestations- see Nursing in Therapy.

First aid

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

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

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

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

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

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

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

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

Pulmonary edema

Clinical manifestations

It is necessary to differentiate pulmonary edema from cardiac asthma.

1. Clinical manifestations of cardiac asthma:

1) frequent shallow breathing;

2) expiration is not difficult;

3) orthopnea position;

4) during auscultation, dry or wheezing rales.

2. Clinical manifestations of alveolar pulmonary edema:

1) suffocation, bubbling breath;

2) orthopnea;

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

4) tachycardia;

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

First aid

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

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

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

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

5) in case of high blood pressure, inject intravenously 1–2 ml of a 5% solution of pentamin, dissolved in 20 ml of physiological saline, 3–5 ml each 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. In the anamnesis there are no indications of diseases of the cardiovascular, respiratory systems, gastrointestinal tract, 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) carry out rehydration with a 0.9% sodium chloride solution intravenously at a rate of 200 ml infusion over 15 minutes. under the control of the level of blood pressure and spontaneous breathing (cerebral edema is possible with too rapid rehydration);

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

Acute abdomen

Clinical manifestations

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

2. Soreness on palpation of the anterior abdominal wall.

3. Symptoms of peritoneal irritation.

4. Tongue dry, furred.

5. Subfebrile condition, hyperthermia.

First aid

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

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

Gastrointestinal bleeding

Clinical manifestations

1. Paleness of the skin, mucous membranes.

2. Vomiting blood or "coffee grounds".

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

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

5. Tachycardia, hypotension.

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

First aid

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

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

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

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

5) cardiac glycosides according to indications;

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

Renal colic

Clinical manifestations

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

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

3. Dysuric disorders.

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

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

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

7. Kidney stone disease in history.

First aid

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

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

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

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

Anaphylactic shock

Clinical manifestations

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

2. Feeling of fear of death.

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

4. Nausea, vomiting.

5. Seizures.

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

7. Tachycardia, thready pulse, arrhythmia.

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

9. Coma.

First aid

Sequencing:

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

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

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

4) carry out oxygen therapy with 100% oxygen;

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

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

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

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

9) in the absence of the effect of the therapy, repeat the administration of epinephrine 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.