Collapse situation. Providing first aid for fainting and collapse. Pre-hospital assistance

The term collapse defines a severe pathological condition of the child, in which a significant decrease in the tone of the smooth muscles of the walls develops arterial vessels, as a result of which the level of systemic blood pressure. This condition requires emergency care, as it can lead to a sharp deterioration. functional state of all organs and systems, resulting from impaired blood flow in them. First of all, against the background of collapse, the central nervous system suffers, since neurocytes (cells nervous system) are very sensitive to oxygen starvation.

Reasons

A sharp and pronounced decrease in the tone of the smooth muscle structures of the walls of arterial vessels is a polyetiological pathological condition, the development of which can be caused by several causes. The most common of these in children are:

A significant increase (hyperglycemia) or decrease (hypoglycemia) in blood sugar levels.
Insufficiency of the functional activity of the adrenal glands, which produce hormones that increase the tone of the smooth muscles of the artery walls (glucocorticosteroids, adrenaline, norepinephrine).
Poisoning of the body associated with exogenous (from outside) intake of various toxins.
Severe course infectious pathology with severe intoxication of the child’s body.
Somatic pathology with damage internal organs, hearts, endocrine glands in the stage of decompensation.

For girls in puberty the development of vascular collapse is possible, which can be triggered by exposure to psycho-emotional stress factors.

Clinical picture

The development of collapse is characterized by the manifestation of a fairly characteristic clinical picture with the following symptoms:

In general, the severity of the child’s condition is determined by the severity of the decrease in systemic blood pressure. The lower it is, the worse condition and more pronounced clinical picture collapse.

Pre-hospital assistance

When the first clinical signs development of collapse in a child should be immediately called ambulance. Before the arrival of medical specialists, assistance is provided prehospital stage, which includes several events:

Further measures require intravenous or intramuscular injection medicines that are performed medical specialists already in the ambulance. After the child is hospitalized, care at the hospital stage necessarily includes objective diagnosis reasons for the development of collapse.

Fainting (syncope)

Sudden short-term loss of consciousness caused by cerebral ischemia (brain oxygen consumption drops by 1/3).

Fainting can be caused by:

vasovagal syndrome, which is based on reflex dilatation of peripheral veins; characterized by sudden development sinus bradycardia. pallor, a sharp decrease in blood pressure, loss of consciousness may be preceded by the appearance of lightheadedness, weakness, nausea; often develops in healthy people at the sight of blood, under the influence of pain or strong emotions, as well as various diagnostic and medical procedures(bronchoscopy, gastroscopy, tracheal intubation, etc.);
orthostatic hypotension (with neurocirculatory dystonia of the hypotensive type, hypokinesia, anemia, bilateral sympathectomy, treatment with ganglion blockers);
acute decrease in circulating blood volume ( internal bleeding, deletion large quantity ascitic fluid, abundant diuresis after the use of potent diuretics, etc.);
heart rhythm disturbances accompanied by a sharp decrease in cardiac output ( ventricular tachycardia, ventricular fibrillation, complete AV block with Morgagni-Adams-Stokes syndrome);
sharp decline cardiac output with heart defects (aortic stenosis with physical activity, mitral stenosis in the presence of a spherical thrombus in the left atrium);
aortic arch syndrome (stenosis or occlusion of the common carotid artery, defeat vertebral arteries, dissecting aortic aneurysm);
increased activity carotid sinus (squeezing it causes vasodilation, bradycardia, decreased blood pressure);
acute pulmonary hypertension(with pulmonary embolism, coughing attacks);
hypoglycemia, hyperventilation;
primary diseases nervous system (epilepsy, hysteria, brain tumor, stroke, brain injury).

Clinic: loss of consciousness occurs suddenly, or is preceded by dizziness, weakness, or lightheadedness. The patient falls or slowly sinks to the floor (ground). Pallor, low blood pressure, weak filling pulse (frequency and rhythm depend on the cause of fainting). The pupils are narrow and reactive to light. The horizontal position of the patient helps to improve blood supply to the brain, consciousness returns, the skin turns pink, the pulse rate improves, blood pressure normalizes.

Fainting should be differentiated from a sudden stop of blood circulation (in contrast to the latter, when fainting, the pulse is at large arteries and heart sounds are preserved). Cardiac auscultation data and ECG data allow us to identify disorders heart rate and conductivity, signs of heart disease, aortic pathology or functional changes.

History helps establish internal bleeding in the patient peptic ulcer. Choking and cyanosis indicate the presence of thromboembolism pulmonary artery. Facial hyperemia, slow, hoarse breathing, arterial hypertension allow one to suspect a cerebrovascular accident

Urgent Care: it is necessary to lay the patient horizontally on his back, raise his legs, unfasten the collar, bring a swab moistened with ammonia to his nose, spray his face cold water, pat on the cheeks. If this is not enough, 1 ml of a 10% caffeine solution or 2 ml of cordiamine is injected under the skin.

For bradycardia, 0.5-1 ml of a 0.1% atropine solution is administered intravenously or intramuscularly. If fainting is caused organic disease, hospitalization in a specialized department is necessary (taking into account the profile of the disease). If the syncope is of a functional nature, hospitalization is not required.

Collapse

Collapse- the most severe form of acute vascular insufficiency, characterized by a sharp decrease in blood pressure and disorder peripheral circulation. It differs from shock in the absence of signs of heart failure (there is no congestion in the lungs, the neck veins are collapsed). Most common reasons; acute infections, blood loss, intoxication, allergic reactions, overdose antihypertensive drugs, fluid loss, acute (exacerbation of chronic) adrenal insufficiency.

Clinic: general condition is serious, facial features are pointed, skin is pale, adynamic, cold sweat, decreased temperature of the extremities. The pulse is frequent, low filling, blood pressure is sharply reduced (may not be detected).

Urgent Care: intravenous drip polyglucin 500 ml, rheopolyglucin 400-800 ml, prednisolone 90-120 mg (or hydrocortisone 125-250 mg), norepinephrine (2-3 ml of 0.2% solution).

For adrenal insufficiency: in addition to glucocorticoids, 2 ml of 0.5% is administered intramuscularly oil solution deoxycorticosterone acetate.

Urgent hospitalization by the team intensive care to a specialized department (intensive care unit) of the hospital, taking into account the profile of the underlying disease.

B.G. Apanasenko, A.N. Nagnibeda

Acute vascular insufficiency in the form of collapse occurs when the ratio between the BCC and the capacity of the vascular bed changes. The main pathogenetic factors of collapse are sharp drop vascular tone(especially venous), decrease in blood volume. Unlike fainting, the key element of collapse is serious violation functions of vasomotor centers with a progressive decrease in venous return of blood to the heart, a decrease in its (heart) work, deterioration of blood supply to the brain.

Clinical picture: sharp deterioration general condition, pronounced pallor skin(sometimes - marbled coloration of the skin), dizziness, chills, cold sweat, sharp decrease in blood pressure, rapid and weak pulse, frequent shallow breathing. Peripheral veins become empty, their walls collapse, which makes venipuncture difficult. Patients remain conscious, but are indifferent to what is happening.

Collapse can be a symptom of such severe pathological processes as acute heart attack myocardium, shock (including anaphylactic - see above), internal or external bleeding, etc., which, of course, matters when choosing therapeutic tactics. Therefore, the implementation of differential diagnostic techniques and pathogenetic treatment of a patient for collapse should be carried out in conditions specialized hospital. The task of a doctor engaged in outpatient dental practice is to take measures to hospitalize the patient as quickly as possible and provide emergency symptomatic care, the algorithm of which is presented in the diagram.

Emergency care algorithm for collapse

When is it appropriate to provide first aid for a collapse?

If a person has vascular collapse, it should be carried out as quickly as possible. This condition is expressed very clearly, it cannot be confused with any other disease. The symptoms are as follows:

A sudden and sharp deterioration in a person’s well-being, while there may not have been any external prerequisites for this phenomenon.
The appearance of causeless and very intense headache.
The darkness before the patient's eyes is expressed by the strong dilation of his pupils.
A person notices the appearance of tinnitus.
Pain syndrome in the heart area. Moderate discomfort may occur.
Severe weakness, often loss of orientation in space. This condition differs from fainting, since even when the person comes to his senses, he does not have the strength to get up quickly.
Decreased blood pressure.
The skin turns pale. This phenomenon occurs as quickly as the appearance of other signs of collapse. After several minutes without assistance, the skin becomes very moisturized and becomes cold. Then they become cyanotic.
There is a sharpening of facial features.
Changes in breathing appear. It becomes very frequent, and its sound is clearly audible, since it is carried out at an impetuous pace.
It is very difficult to feel the patient's pulse.
Often a person loses consciousness for a long time, and without rehabilitation measures he may not come to his senses.

First aid

Every person is capable of providing first aid in case of collapse. You don't have to be a doctor to do this. You should know how emergency care is provided in case of collapse. The algorithm of actions is quite extensive. You need to learn it and be able to implement it so as not to get confused when another person develops a critical condition.

If you don't do the right things, the negative state will most likely end fatal. When performing all the points, you must remember that any delay has a detrimental effect on the patient, so assistance should be provided quickly and decisively.

If a person has collapsed in crowded place and providing first aid is inconvenient, it must be positioned correctly. The patient is located in supine position. He needs to be placed on his back and ensure balance. It is advisable to choose a hard surface without protrusions so as not to injure a person.

It is not advisable to transfer the patient to the bed, since its softness will interfere with the performance further actions. If nothing even is found, you can lay the person on the floor, having first covered the surface with a cloth. You should bend your head a little. You can place a small pillow or other soft thing under it. The legs should be raised and locked in this position. You can place a bundle of some material under them by rolling up a voluminous roller. If there are no suitable things, one of those present can independently hold their legs in an elevated position.

List of necessary actions

Emergency care for collapse requires that everything that can compress the patient’s body and prevent him from breathing calmly must be removed or unfastened. It is necessary to remove the belt, unfasten the cuffs, and also the collar. You can remove as much clothing as possible, but you should do it all quickly.
Someone needs to call an ambulance while emergency care for the collapse is being carried out. If among those present there is a doctor or a person experienced in providing first aid, it is necessary that he is the one who deals rehabilitation measures. If a person who is able to provide assistance is alone, then it is advisable to simultaneously call an ambulance and continue to perform necessary measures upon the return of consciousness to the patient.
There should be a lot in the room fresh air. The window should be opened. If possible, inhale oxygen.
The patient benefits from warmth. Before the doctors arrive, it is necessary, if possible, to make the air in the room warm using a heater, and cover the patient with heating pads on all sides of the body.
It is brought to a person's nose. This can bring him to consciousness. If this tool out of stock, you can perform other actions aimed at activating brain activity. This is a massage of both earlobes, temples, and also the area where the depression is located above the upper lip.

Features of the assistance process

In case of collapse, which is a consequence of large blood loss, it is necessary to eliminate the cause heavy bleeding as quickly as possible. A tourniquet is usually applied to prevent death once collapse occurs. The clinic where emergency care will take place after the doctors arrive is responsible for further therapeutic measures. When the patient comes to his senses, he should be given complete rest. You should not constantly ask him about his well-being. It is better to observe his condition from the side.

Prohibited actions

When emergency care is provided for collapse, the patient should not be asked to drink painkillers or take any medications that affect the dilation of blood vessels. This can lead to dire consequences and even death.
Try to mechanically push liquid or any liquid into the patient’s esophagus medications, if he is sleeping, it is impossible. At unsuccessful attempt Reflexive cessation of breathing may occur.
Slap a person in the face, bringing him to consciousness. Often these actions do not improve the situation, but only increase the patient’s stress.

Relevance of medications for collapse

Drug treatment is usually prescribed by a doctor, but if those around you have the proper qualifications or if it is impossible to go to the hospital, you can choose the drugs yourself. When shock or collapse occurs, emergency care is very important. If medications are not available, you should immediately send someone to the pharmacy to get them. First, substances are introduced into the body aimed at normalizing blood circulation processes.

Basic medications for collapse

Usually done first intravenous infusion using drugs such as sodium chloride or Ringer's solution. There is no fixed quantity assigned. When determining the dose, one should be guided by external signs patient:

The general condition of a person, a set of indicators that determine the viability and prognosis of the disease.
Skin tone. The complexion, in particular the nasolabial triangle, is especially important. It shouldn't be too pale. If the color is close to white, more vasodilator solution will be required.
Absence or presence of diuresis.
Blood pressure.
The frequency of heart beats, as well as the intensity of the pulse in different parts bodies.

Additional drugs

Anti-inflammatory drugs are needed. In case of collapse, it is advisable to administer the following drugs: "Metypred", "Triamcinolone" or "Prednisolone".
Vasopressors can also be administered intravenously.
The spasm should be relieved quickly. To do this, you can even introduce a regular solution of novocaine. If it is more convenient to give an injection intramuscularly, it is advisable to use Aminazine.

Emergency care in case of collapse is necessary, since an ambulance cannot always get there quickly. To be able to provide real help a person should remember the set of instructions and, if necessary, follow them accurately. Often, providing assistance when collapse occurs is the only way, thanks to which a person’s life is saved.

To one of the most dangerous pathological conditions include collapse, which, having pronounced symptoms, without medical intervention leads to death.

A critical situation causes a condition circulatory system: vascular tone decreases, which affects a sharp decrease in the total volume of blood circulating throughout the body. The brain stops receiving required quantity oxygen, so its cells begin to die quickly. Considering the critical condition of the patient, first aid in case of collapse is provided by eyewitnesses or relatives of the patient. From right actions rescuers at the stage before hospitalization and the speed of arrival of doctors to the victim determine the further prognosis of a person’s life.

Factors provoking a dangerous condition

What is collapse? This term literally translates as “fallen.” This name is associated with the sharpness to a critical level during an attack.

There are 2 reasons that cause a critical condition:

Significant and rapid blood loss, due to which the total blood mass in the arteries and veins decreases;
The destructive effects of toxic or poisonous substances, the effects of which reduce elasticity vascular walls, reducing the overall tone of the circulatory system.

The pathological process progresses rapidly, due to the constantly increasing hypoxia of all systems and organs. The brain stops receiving oxygen, without which it cannot work, so the pressure in the arteries decreases even more, which poses a direct threat to the patient’s life.

Let us list the factors that provoke the development of collapse:

Excessive internal or external bleeding;
With medications: neuroleptics, sympatholytics, adrenergic blockers;
Toxic effects;
Rapid change of body position for people who do not get out of bed due to illness;
Low oxygen content in the room;
Dehydration;
Previously acquired infectious diseases;
Puberty (more often in girls);
Pathological disorders of the myocardium, for example, with;
Heart disease: hemopericarditis.

Pay attention!

The occurrence of collapse is most often associated with complications infectious diseases or severe pathological conditions.

At risk are patients who have suffered from and those with adrenal dysfunction.

The severity of the victim’s condition during the development of an attack depends on several factors:

Age characteristics (in younger children and old age the pathology is more severe);
The degree of adaptation of the victim’s body to damage;
Emotional and psychological characteristics of the patient.

In order for first-aid for a collapse to be provided correctly, it is necessary to find out the disease or factor that caused the attack, evaluate the symptoms, and check the basic reflexes. Only after these conditions are met do emergency care for collapse begin.

Classification and features of the course of an emergency condition

The manifestations of collapse are divided according to several criteria. Doctors most often use the classification of emergency conditions according to etiological factor. Let us consider the types and features of manifestations of collapse according to this division.

view. It is a consequence of infectious diseases caused by bacteria.
Toxic look. The appearance of collapse is associated with the impact toxic substances on the human body. Most often, such lesions occur due to professional activity the victim.
Hypoxemic appearance. Meteosensitive people are susceptible to such collapse during high values atmospheric pressure or a small amount of oxygen in the room air.
Pancreatic view. Occurs due to injury or pathological changes in the pancreas.
Burn appearance. Called deep lesions skin as a result.
Hyperthermic appearance. Provoked sunstroke or long-term exposure high temperatures.
Dehydration appearance. Caused by extreme dehydration of the body.
collapse. Occurs against the background of massive internal or external bleeding.
Cardiac () collapse. Dangerous condition provoke.
Orthostatic collapse. It occurs due to a sudden change in body position in bedridden patients. However, manifestations of pathology can also occur in healthy people, especially in adolescence and childhood.
Plasmoragic type. The origin of the collapse is due to severe diarrhea.

IN separate group enterogenous type, or, as it is also called, fainting, which occurs in patients with gastrectomy after a heavy meal.

Characteristic symptoms

Before providing first aid for shock, fainting and collapse, you need to assess the condition of the victim.

The symptoms of an attack caused by a lack of circulating blood are pronounced. The main signs that the victim needs help first aid the following:

Sudden deterioration in general health;
accompanied by dizziness;
The victim feels weak, his vision becomes dark, and noise is heard in the ears;
A barely audible but very rapid pulse;
Reducing blood pressure to critical levels;
The skin quickly turns pale, then turns blue;
There is discomfort in the heart area;
The patient feels cold and chilly;
Frequent, intermittent and shallow breathing;
Confusion of consciousness, which manifests itself in the patient’s complete indifference to everything that happens;
The face is covered with cold sweat, the tongue is dry;
Possible nausea, turning into;
Sharpening of facial features.

Very in serious condition, if first aid is not provided in time for collapse, fainting will occur with the loss of all reflex movements or shock.

It should be noted that vascular collapse is less dangerous pathology, how . However, in this case, delay on the part of rescuers or a doctor will cost the victim his life.

Specifics of urgent actions

Before providing first aid for fainting and collapse, you must urgently call an ambulance, explaining in detail the condition of the victim.

Then pre-medical measures are carried out according to the following algorithm of actions:

The patient is placed on a hard, flat surface on his back;
You need to raise his legs by placing rolled-up clothes or a blanket under them;
When bringing a person to consciousness, turn his head to the side;
Provide the victim with the opportunity to breathe freely by unbuttoning or removing all oppressive clothing;
If the attack occurred indoors, open all the windows so that there is free circulation of fresh air in the room;
Place warm heating pads on the patient’s arms and legs;
When or when a person is unconscious, bring a cotton swab soaked in ammonia to his nose;
In case of absence medication use the technique of rubbing the temples or earlobes.

If collapse was caused by injury and blood loss, emergency care begins with. After the victim has regained consciousness, and the doctors have not yet arrived, provide him with complete emotional and physical rest.

When first aid is provided for fainting and collapse, the following actions are prohibited:

Offer the patient any medications;
In an unconscious state, he is forbidden to pour water into his mouth;
To bring a person to his senses by slapping his cheeks or shaking him.

Pay attention!

The collapse caused by is stopped by twists and turns! Simply apply an ice pack to the injured area.

Medical assistance

First medical care turns out to be an ambulance crew. Their task is to restore natural blood circulation in the body. For these purposes, perform the following actions:

Administration of intravenous sodium chloride or Ringer's solution;
Use of glucocorticoids and antispasmodics;
Intravenous administration of vasopressors.

The dosage and selection of drugs is carried out taking into account the following indicators:

Skin color;
Blood pressure;
Number and frequency of heartbeat;
Presence or absence of diuresis.

After hospitalization they carry out complex therapy, which is designed to influence the body in 4 directions.

Eliminate factors that threaten the life of the victim;
Block the causes that caused the state of collapse;
Restore lost body functions;
Prevent possible respiratory failure with oxygen therapy.

Despite the wide variety of types of pathological conditions that cause collapse, they are all extremely dangerous to human life and require immediate assistance doctors