Fainting is a sudden, short-term loss of consciousness that occurs as a result of 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. Unexpected sharp pain, fear, nervous shock.

They can cause an immediate decrease in blood pressure, resulting in a decrease in blood flow, disruption of 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, resulting from a variety of reasons, ranging from hunger, poor nutrition and ending with constant anxiety, can also lead to low blood pressure and fainting.

3. Staying in a room with insufficient oxygen.

Oxygen levels can be reduced due to large numbers of people indoors, poor ventilation, and air pollution from tobacco smoke. As a result, the brain receives less oxygen than needed, and the victim faints.

4. Staying in a standing position for a long time without moving.

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:

Reaction - short-term loss of consciousness, the victim falls. In a horizontal position, blood supply to the brain improves and after some time the victim regains consciousness.

Breathing is rare and shallow. Blood circulation - pulse is weak and rare.

Other signs are dizziness, tinnitus, severe weakness, blurred vision, cold sweat, nausea, numbness of the limbs.

First aid for fainting

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

2. Unfasten tight parts of clothing, such as collars and belts.

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

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

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

6. You should not rush to raise the victim after he has regained consciousness. If conditions allow, the victim can be given hot tea, and then helped to rise and sit down. If the victim again feels fainting, he must be laid on his back and his legs raised.

7. If the victim is unconscious for several minutes, most likely it is not fainting and qualified medical attention 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 impaired for two reasons:

Heart problems;

Reducing the volume of fluid circulating in the body (severe bleeding, vomiting, diarrhea, etc.).

Symptoms and signs of shock:

Reaction - the victim is usually conscious. However, the condition can worsen very quickly, even to the point of 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 problems.

Breathing is frequent and shallow. This breathing is explained by the fact that the body is trying to get as much oxygen as possible with a limited blood volume.

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

Other signs are skin that is pale, especially around the lips and earlobes, and 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. Sweat glands also enhance activity. The victim may feel thirsty due to the fact that the brain senses 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. Chills mean lack of oxygen.

First aid for shock

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

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

The victim must be placed on his back with something under his head.

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

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

3. If shock is caused by cardiac dysfunction, the victim must be placed in a semi-sitting position, placing pillows or folded clothing under the head and shoulders, as well as under the knees.

It is not advisable to lay the victim on his back, as this will make it more difficult for him to breathe. Give the victim an aspirin tablet to chew.

In all of the above cases, you must call ambulance and before her arrival, monitor the condition of the victim, being ready to begin cardiopulmonary resuscitation.

When providing assistance to a victim in shock, it is unacceptable:

Move the victim, except when necessary;

Allow the victim to eat, 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 heat source.

ANAPHYLACTIC SHOCK

Anaphylactic shock is an immediate widespread allergic reaction that occurs when an allergen enters the body (insect bites, medicinal or food allergens).

Anaphylactic shock usually develops within a few 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 due to asphyxia or after 24-48 hours or more due to severe irreversible changes in life important organs.

Sometimes death 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 sense of fear, and as shock develops, loss of consciousness is possible.

Airways - swelling occurs respiratory tract.

Breathing - similar to asthmatic. Shortness of breath, a feeling of tightness in the chest, coughing, intermittent, difficult, may stop completely.

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

Other signs are a tense chest, 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 sit 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 begin cardiopulmonary resuscitation.

ATTACK OF BRONCHIAL ASTHMA

Bronchial asthma is an allergic disease, the main manifestation of which is an attack of suffocation caused by obstruction of the bronchial tubes.

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 in 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, during severe attacks he may not be able to utter several words in a row, and he may lose consciousness.

Airways may be narrowed.

Breathing - characterized by difficult, prolonged exhalation with a lot of wheezing, often heard at a distance. Shortness of breath, cough, dry at first, and at the end with 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 thread-like until the heart stops.

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

First aid for an attack of bronchial asthma

1. Take the victim out into the fresh air, unfasten the collar and loosen the belt. Sit leaning forward and focusing on your 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 difficulty breathing and finds it difficult to speak;

The victim showed signs of extreme exhaustion.

HYPERVENTILATION

Hyperventilation - excessive in relation to the metabolic rate pulmonary ventilation, caused by 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 anxiety caused by fright or some other reason.

Feeling extreme anxiety or panic, a person begins to breathe more quickly, which leads to a sharp decrease in carbon dioxide levels in the blood. Hyperventilation sets in. As a result, the victim begins to feel even more anxious, which leads to increased hyperventilation.

Symptoms and signs of hyperventilation:

Reaction - the victim is usually alarmed and feels confused. The airways are open and free.

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

Blood circulation - does not help to recognize the cause.

Other signs include the victim feeling dizzy, a sore throat, tingling in the arms, legs or mouth, and the heart rate may increase. Seeks attention, help, may become hysterical, faint.

First aid for hyperventilation.

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

Typically, after 3-5 minutes, the level of blood carbon dioxide saturation returns to normal. The respiratory center in the brain receives the appropriate information about this and sends a signal: 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 is emotional arousal, it is necessary to calm the victim, restore his sense of confidence, and persuade the victim to sit calmly and relax.

ANGINA

Angina pectoris (angina pectoris) is an attack of acute pain in the chest caused by transient insufficiency coronary circulation, acute myocardial ischemia.

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

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

However, most often angina still occurs when the coronary arteries are narrowed, which can account for 50–70% of the lumen of the vessel.

Symptoms and signs of angina:

Reaction - the victim is conscious.

The airways are clear.

Breathing is shallow, the victim does not have enough air.

Blood circulation - pulse is weak and frequent.

Other signs - the main sign of pain syndrome is its paroxysmal nature. The pain has a fairly clear beginning and end. The nature of the pain is squeezing, pressing, sometimes in the form of a burning sensation. As a rule, it is localized behind the sternum. Irradiation of pain to the left half is typical chest, in the left hand to the fingers, left shoulder blade and shoulder, neck, lower jaw.

The duration of pain during angina pectoris, as a rule, does not exceed 10-15 minutes. They usually occur during physical activity, most often when walking, and also during stress.

First aid for angina pectoris.

1. If an attack develops during physical activity, it is necessary to stop the exercise, for example, stop.

2. Place the victim in 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 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, a feeling of fullness in the head and headache, sometimes - dizziness, and, if standing, fainting. Therefore, the victim should remain in a semi-sitting position for some time even after the pain goes away.

If nitroglycerin is effective, the angina attack goes away within 2-3 minutes.

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

If, after taking the third tablet, the victim’s pain does not go away and lasts for more than 10–20 minutes, it is necessary to urgently call an ambulance, since there is a possibility of developing a heart attack.

HEART ATTACK (MYOCARDIAL INFARCTION)

Heart attack (myocardial infarction) is necrosis (death) of a section of the heart muscle due to disruption of its blood supply, which manifests itself in impaired cardiac activity.

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

The causes of a heart attack can be:

Atherosclerosis;

Hypertonic disease;

Physical activity combined 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 initial period pain attack, restless behavior, often accompanied by fear of death, later loss of consciousness is possible.

The airways are usually free.

Breathing is frequent, shallow, and may stop. In some cases, attacks of suffocation are observed.

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

Other signs - strong pain in the region of the heart, usually occurring suddenly, often behind the sternum or to the left of it. The nature of the pain is squeezing, pressing, burning. It usually radiates to the left shoulder, arm, and shoulder blade. Often during a heart attack, unlike angina pectoris, the pain spreads to the right of the sternum, sometimes involves the epigastric region and “radiates” 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, and 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 semi-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 tight parts of clothing, especially around the neck.

4. Call an ambulance immediately.

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

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

Stroke is an acute disturbance of blood circulation 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 may be a cerebral hemorrhage, cessation or weakening of the blood supply to any part of the brain, blockage of a vessel by a thrombus or embolus (a thrombus is a dense clot of blood in the lumen of a blood vessel or heart cavity, formed during life; an embolus is a substrate circulating in the blood, not occurring under normal conditions and capable of causing blockage blood vessels).

Strokes are more common in older people, although they can occur at any age. More often observed in men than in women. About 50% of stroke victims die. Of those who survive, approximately 50% are crippled and have another stroke weeks, months or years later. However, many stroke survivors regain their health with the help of rehabilitation measures.

Symptoms and signs of stroke:

Reaction - consciousness is confused, there may be loss of consciousness.

The airways are clear.

Breathing - slow, deep, noisy, wheezing.

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

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

With a minor lesion there is weakness, with a significant one - complete paralysis.

First aid for stroke

1. Call qualified medical assistance immediately.

2. If the victim is unconscious, check whether the airway is open, and restore airway patency if it is compromised. 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 of the condition and for cardiopulmonary resuscitation.

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

5. The victim may have a mini-stroke, in which there is a slight speech disorder, slight clouding of consciousness, slight dizziness, and 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. Control DP - D - K and be ready to provide emergency assistance.

EPILEPTIC ATTACK

Epilepsy - chronic illness caused by brain damage, manifested by repeated convulsive or other seizures and accompanied by a variety of personality changes.

An epileptic seizure is caused by excessively intense stimulation of the brain, which is caused by an imbalance in the human bioelectric system. Typically, a group of cells in one part of the brain becomes electrically unstable. This creates a strong electrical discharge that rapidly spreads to surrounding cells, disrupting their normal functioning.

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

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

Symptoms and signs of petit mal seizure:

Reaction - temporary loss of consciousness (from several seconds to a minute). The airways are open.

Breathing is normal.

Blood circulation - pulse is normal.

Other signs are a blank gaze, repeated or twitching movements of individual muscles (head, lips, arms, etc.).

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

First aid for petit mal seizure

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

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

3. If this is the first seizure, consult a doctor.

Grand mal seizure is sudden loss consciousness, accompanied by severe spasms (convulsions) of the body and limbs.

Symptoms and signs of grand mal seizure:

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

The airways are clear.

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

Other signs are that the victim usually falls to the floor unconscious, and begins to experience sudden 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 cyanotic. The pupils do not react to light. Foam may appear at the mouth. The total duration of the seizure ranges from 20 seconds to 2 minutes.

First aid for grand mal seizure

1. If you notice that someone is on the verge of a seizure, you need to try to ensure that the victim does not hurt himself if he falls.

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

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

4. Do not attempt to restrain the victim. If his teeth are clenched, do not try to unclench his jaws. Do not try to put anything into the victim’s mouth, as this can lead to injury to the teeth and closure of the respiratory tract with fragments.

5. After the convulsions have stopped, move the victim to a safe position.

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

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

The seizure happened for the first time;

There was a series of seizures;

There is damage;

The victim was unconscious for more than 10 minutes.

HYPOGLYCEMIA

Hypoglycemia - low blood glucose levels 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 like 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) in case of insulin overdose.

Symptoms and signs of hypoglycemia:

Reaction: consciousness is confused, loss of consciousness is possible.

The airways are clean and free. Breathing is rapid, shallow. Blood circulation - rare pulse.

Other signs are weakness, drowsiness, dizziness. Feelings of hunger, fear, pale 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 per glass of water), a piece of sugar, chocolate or candy, maybe caramel or cookies. Sweetener doesn't help.

3. Ensure rest until the condition is completely normalized.

4. If the victim loses consciousness, transfer him to a safe position, call an ambulance and monitor his condition, and be ready to begin cardiopulmonary resuscitation.

POISONING

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

Toxic substances can enter the body in various ways. There are different classifications of poisoning. For example, poisoning can be classified according to the conditions under which toxic substances enter the body:

During meals;

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;

Drug poisoning;

Alcohol poisoning;

Poisoning chemicals;

Gas poisoning;

Poisoning caused by insect, snake, and animal bites.

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

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 victim's reaction, airway, breathing and blood circulation, and take appropriate measures if necessary.

5. Call an ambulance.

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

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

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

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

Emergency

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

Urgent

Medical care provided for sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs threats to the patient's life.

Planned

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

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

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

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

Sign	Medical assistance form
	Emergency	Urgent
Medical criterion	Threat to life	There is no obvious threat to life
Reason for providing assistance	The patient’s request for help (expression of will; contractual regime); treatment of other persons (lack of expression of will; legal regime)	Request by the patient (his legal representatives) for help (contractual regime)
Terms of service	Outside a medical organization (pre-hospital stage); in a medical organization (hospital stage)	Outpatient (including at home), as part of a day hospital
Person obliged to provide medical care	A doctor or paramedic, any medical professional	Medical specialist (therapist, surgeon, ophthalmologist, etc.)
Time interval	Help must be provided as quickly as possible	Assistance must be provided within a reasonable time

But unfortunately, this is also not enough. In this matter, we definitely cannot do without the participation of our “legislators”. Solving the problem is necessary not only for theory, but also for “practice”. One of the reasons, as mentioned earlier, is the obligation of each medical organization to provide emergency medical care free of charge, while emergency care can be provided on a paid basis.

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

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

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

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

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

Some TPGGs indicate that the provision of emergency medical care is carried out in accordance with emergency medical care standards, approved by orders of the Russian Ministry of Health, according to conditions, syndromes, diseases. And, for example, the 2018 TPGG of the Sverdlovsk region means that emergency care is provided in outpatient, inpatient conditions and conditions of day hospitals in the following cases:

• when emergency condition at the patient on the territory of the medical organization (when the patient seeks medical care in a planned form, for diagnostic studies, consultations);
• when the patient self-refers or is delivered to a medical organization (as the closest one) by relatives or other persons in the event of an emergency;
• if an emergency condition occurs in a patient during treatment in a medical organization, during planned manipulations, operations, or studies.

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

Unfortunately, Federal Law No. 323 contains only the analyzed concepts themselves without the criteria that “separate” these concepts. As a result, a number of problems arise, the main one of which is the difficulty of determining in practice the presence of a threat to life. As a result, there is an urgent need for a clear description of diseases and pathological conditions, signs indicating a threat to the patient’s life, with the exception of the most obvious (for example, penetrating wounds of the chest, abdominal cavity). It is unclear what the mechanism for identifying a threat should be.

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

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

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

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

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

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

However, the situation in providing medical care in emergency form(which is also considered a medical intervention) falls within the exception. Namely, medical intervention is allowed without the consent of a person for emergency reasons to eliminate a threat to a person’s life, if the condition does not allow one to express one’s will, or if there are no legal representatives (clause 1 of part 9 of article 20 of Federal Law No. 323). The basis for disclosing medical confidentiality without the patient’s consent is similar (clause 1 of part 4 of article 13 of Federal Law No. 323).

In accordance with clause 10 of Article 83 of Federal Law No. 323, expenses associated with the provision of free emergency medical care to citizens by a medical organization, including a medical organization of the private healthcare system, are subject to reimbursement. Read about reimbursement of expenses for the provision of emergency medicine in our article: Reimbursement of expenses for the provision of free emergency medical care.

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

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

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

The article uses materials from the article by A.A. Mokhov. Features of providing emergency and emergency care in Russia // Legal issues in healthcare. 2011. No. 9.

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Emergency conditions are usually called such pathophysiological changes in the human body that lead to a sharp deterioration in health and can threaten life under various external and internal factors of aggression. The phase of the general reaction of the body begins with stimulation of the hypothalamic-pituitary, and through it, the sympathetic-adrenal system. Depending on the strength, duration and degree of influence of the aggression factor on the body, the response can remain within the limits of compensatory capabilities, and with imperfect reactivity of the body and concomitant pathology of any functional systems, it becomes inadequate, leading to disruption of homeostasis.

The mechanism, or pathogenesis, of emergency conditions in these conditions turns into thanatogenesis (the physiological process of dying, named after the ancient Greek god of death Thanatos), when previously beneficial hyperventilation leads to respiratory alkalosis and a decrease in cerebral blood flow, and the centralization of hemodynamics disrupts the rheological properties of the blood and reduces it volume.

The hemostatic reaction turns into diffuse intravascular coagulation with dangerous thrombus formation or uncontrollable bleeding. Immune and inflammatory reactions do not protect, but contribute to anaphylactic reactions in the form of laryngo- and bronchiolospasm, shock, etc. Not only reserves of energy substances are consumed, but also structural proteins, lipoproteins, and polysaccharides are burned, reducing the functionality of organs and the body as a whole. Decompensation of the acid-base and electrolyte state occurs, and therefore enzymatic systems, tissue enzymes and other biologically active substances (BAS) are inactivated.

These interdependent and mutually reinforcing disorders of the vital functions of the body can be represented in the form of intertwining cycles of homeostasis disorders, discussed in the monograph by A.P. Zilber " Clinical physiology in anesthesiology and resuscitation" (1984) within the framework of the Intensive Care Anesthesiology and Resuscitation (ITAR) system. The first circle characterizes a violation of the regulation of vital functions, when not only the central regulatory mechanisms (nervous and hormonal) are damaged, but also tissue (kinin systems, biologically active substances such as histamine, serotonin, prostaglandins, cAMP system), regulating blood supply and metabolism of organs, permeability of cell membranes, etc.

The second vicious circle reflects changes in the fluid media of the body, when syndromes that are mandatory for critical conditions of any etiology develop: violation of the rheological properties of blood, hypovolemia, coagulopathy, changes in metabolism.

The third vicious circle - shows organ disorders, including: functional failure of the lungs (1), blood circulation (2), liver (3), brain (4), kidneys (5), gastrointestinal tract (6). Each of these disorders can be expressed to varying degrees, but if a specific pathology has reached the level of a critical condition, elements of all these disorders always exist, so any emergency condition should be considered as multiple organ failure requiring emergency medical care.

During outpatient dental interventions, the following emergency conditions are distinguished:

• respiratory disorders due to disorders external respiration and asphyxia;
• cardiovascular disorders, including fainting, collapse, arrhythmias, angina pectoris, hypertensive crisis, myocardial infarction, hypotension, vascular dystonia;
• comatose states with diabetes, increased intracranial pressure(epilepsy), kidney damage; 1"
• shock manifestations as a result of an acute pain reaction, injury, allergic reaction for medications (anaphylactic shock), etc.

Providing assistance in emergency situations consists of intensive implementation of appropriate therapeutic measures. In the process of monitoring the patient’s condition, a number of clinical signs may appear:
! State of consciousness and psyche- the initial, mildest changes in consciousness are manifested by the patient’s lethargy, his indifference to the environment. Answers questions correctly, reasonably, but sluggishly. Disorientation in time and space is not expressed; answers to questions are given with a delay. In some cases, initial changes in the psyche are manifested by speech and motor agitation, disobedience, and aggressiveness, which is assessed as a stuporous state (numbness). If the patient is completely indifferent to his surroundings, does not answer questions, but the reflexes are preserved, this indicates stupor, or stupor. The extreme degree of impairment of consciousness is coma (hibernation), when there is a complete loss of consciousness, sensitivity and active movements due to the loss of reflexes.
! Patient position- can be active, passive and forced. The passive position indicates the severity of the patient’s condition, who is inactive, relaxed, and slides towards the foot end of the chair. A forced position is typical for respiratory complications, shortness of breath, cough, and asphyxia.
! Facial expression- determines the general condition of a person: a painful expression occurs with strong pain reactions and mental experiences; pointed and expressionless facial features indicate intoxication, unrecovered blood loss, dehydration; a swollen, swollen and pale face is characteristic of kidney patients; a mask-like face indicates brain damage, especially with combined injuries to the jaws and head.
! Skin- increased skin moisture is considered one of the reactions of adaptation and psycho-emotional stress. Excessive sweating is characteristic of circulatory disorders (drop in blood pressure, temperature, etc.). Profuse cold sweat is an unfavorable symptom and is observed with fainting, collapse, asphyxia, and terminal conditions. Determining skin turgor (elasticity) is important. A decrease in skin turgor is observed with dehydration in weakened and cancer patients. Some patients have a pale, gray-tinged skin color, which indicates circulatory disorders and intoxication of the body in chronic diseases of the cardiovascular system and parenchymal organs.

Peripheral cyanosis(acrocyanosis) depends on slowing blood circulation and reducing oxygen utilization by tissues. In this case, the cyanosis is most noticeable on the tip of the nose, lips, ears, and fingernails. This type of cyanosis occurs with mitral defects and circulatory disorders of cardiac origin due to a decrease in cardiac output.

Central cyanosis, in contrast to the peripheral, is manifested by uniform cyanosis of the body as a result of decreased arterialization venous blood in the lungs, which usually happens when severe forms pneumosclerosis, emphysema, asphyxia. Increasing cyanosis of any origin has an unfavorable prognosis and requires emergency measures.

Swelling in tissues and intertissue spaces- As a rule, it is permanent in nature, due to the corresponding pathology. Edema of cardiac origin manifests itself in the legs, renal - on the face, eyelids, cachectic - everywhere, in all tissues and organs of the body. Only swelling of allergic origin is short-lived - Quincke's edema, which is characterized by paroxysmal manifestations on the skin of the face (eyelids, cheeks, lips, oral mucosa), as well as on the hands. It can spread to the larynx, trachea, and esophagus, which requires urgent treatment. Swelling of a certain anatomical area can occur with phlebitis and thrombophlebitis, in particular swelling of the anterior facial vein, which is characterized by pain and one-sided manifestation.

In addition to the clinical manifestations of somatic disorders, their confirmation is required using laboratory tests and instrumental data, however, during outpatient visits, these possibilities are limited, and we can only talk about the need to measure blood pressure, count the pulse rate, respiration, and analyze blood sugar. Otherwise, much depends on the clarity of actions, experience and intuition of the doctor.

Respiratory disorders- in the dental chair they can be sudden only with asphyxia. At the same time, from all types of asphyxia (dislocation, obstructive, stenotic, valvular, aspiration) the concept of “BOARD” is formed. Dentists often deal with aspiration asphyxia when saliva, blood, tooth fragments, filling material and even small instruments (root needle, pulp extractor) enter the trachea.

Symptoms of acute respiratory failure develop in several phases:
1st phase - strengthening of respiratory functions, during which inhalation lengthens and intensifies - inspiratory shortness of breath, anxiety, cyanosis, tachycardia;
2nd phase - decrease in breathing with a sharp increase in exhalation - expiratory dyspnea, acrocyanosis, bradycardia, drop in blood pressure, cold sweat;
3rd phase - bradypnea, loss of consciousness;
4th phase - apnea, Kus-Maul breathing, or atonal breathing.

In time, one phase replaces another, depending on the reserve capabilities of the body and the urgency of the measures.

Emergency care consists of urgently eliminating the causes of asphyxia, compensating for external respiration by inhaling oxygen or assisted mechanical breathing using a hand-held device RD 1, an Ambu bag (Fig. 42), and an anesthesia machine mask. IN last years Kendall has created a convenient tube that can be used in emergency situations. In addition, drug stimulation with intravenous administration of a respiratory analeptic (2 ml of cordiamine, 2.4% aminophylline solution, 10 ml) is effective. It is necessary to call an ambulance or an anesthesiologist; if the measures taken are ineffective, a tracheotomy or microtracheostomy is indicated - piercing the tracheal diaphragm between the cricoid and thyroid cartilages with a thick needle. The patient is transferred to the hospital. If external respiration is impaired for extrapulmonary reasons in patients with concomitant pathologies such as stroke, myasthenia gravis, hypertensive crisis, etc., emergency care should be aimed at preventing pulmonary edema.

Cardiovascular disorders- most often manifested by fainting, resulting from mental or nervous tension, as well as as a consequence of the manifestation of a psycho-vegetative complication at a dentist’s appointment. Sometimes, after an injection of an anesthetic, accompanied by painful and proprioceptive irritation, a sharp pallor of the patient’s face, ringing in the ears, darkening of the eyes and loss of consciousness suddenly occur. In this case, the pupils remain constricted, the corneal reflex is absent, eyeballs motionless or wandering, weak pulse, shallow breathing, systolic blood pressure within 70-50 mm Hg. Art., the skin is cold and covered with sweat. This state is short-lived (1-1.5 minutes), after which consciousness returns immediately, the patient notes retrograde amnesia.

Emergency assistance in this case consists of urgently placing the patient in a horizontal position. Smoothly recline the back of the chair and remove clothing that is constricting and complicates breathing; ensure the flow of cool air by opening a vent, window or turning on a fan on the dental unit. Next, moisten the tampon in ammonia and squeeze the chest at the moment of its passive expansion, carefully bring the tampon to the nose. Then carry out manual reflexology by massaging the points of general influence on the hands, eyebrows and at the base of the nose. If fainting is prolonged, 2 ml of cordiamine in saline solution is administered intravenously in a 10 gram syringe. For bradycardia - 0.1% atropine solution (0.6-0.8 ml) diluted 1:1 with saline.

The widespread technique of forcibly tilting the head down and forward should be considered unphysiological and even dangerous. On the contrary, it is necessary to ensure blood flow to the heart at the moment of centralization of blood circulation by positioning the “legs at the level of the heart” so that there is a full cardiac output and cerebral blood flow is ensured.

Only after the permanent disappearance of the consequences of fainting and signs of circulatory disorders is it possible to continue dental intervention. The main cause of fainting should be considered a violation of bioenergetics, when insufficiency of the energy production process and oxygen deficiency during psycho-emotional stress lead to metabolic acidosis of tissues and circulatory disorders. Such a patient requires premedication before dental intervention.

Collapse- acute cardiovascular failure caused by blood loss or orthostatic causes leading to a disorder of the microcirculation of the brain, myocardium and internal organs.

Clinically, collapse resembles fainting, but develops gradually when, against the background of pallor, tachycardia, and a sharp drop in blood pressure to 30 mm Hg. Art. and the presence of shallow breathing, loss of consciousness occurs with a delay.

Emergency care consists of quickly increasing vascular tone by intravenous administration of drugs: cordiamine 2 ml in saline solution - 10 ml, followed by mezaton (1% solution, 0.5-1 ml) or norepinephrine (0.2% solution, 0.5 -1 ml) also in 10 ml saline solution slowly. If the previous remedies are ineffective, a drip infusion of a 5% glucose solution (Fig. 43), polyglucin with the addition of 100 mg of vitamin C and 100 mg of prednisolone in 200 or 400 ml is performed. The frequency of drip administration is 60-80 drops per minute under the control of blood pressure and pulse.

It is necessary to call the resuscitation team or the anesthesiologist responsible for the department. The patient is transferred to the hospital.

Arrhythmia- occurs as a result of the reflex effect of a pain reaction coming from the area of ​​the surgical field, or as a result of the pharmacological action of anesthetics against the background of metabolic acidosis due to a stress factor.

Clinically, arrhythmia is manifested by subjective unpleasant sensations in the heart area, a feeling of fluttering, anxiety, signs of circulatory disorders and heart failure (swelling of the saphenous veins, cyanosis in the periphery of the body).

Emergency assistance consists of stopping the intervention and making the patient comfortable. The patient must be given water to drink and take sedatives: tincture of valerian or motherwort, or validol under the tongue, or seduxen 10 mg orally (“per os”) in liquid form. If the arrhythmia is eliminated, this can be limited; if the disorder worsens, it is necessary to call a cardiology team, and until their arrival, provide oxygen therapy, sedation and rest. For paroxysmal tachycardia, beta-blockers are used in the form of a single dose of 5 mg obzidan (anaprilin) ​​orally.

Arrhythmia is dangerous due to myocardial infarction, the clinical picture of which is brighter and corresponds to an acute heart attack of angina pectoris: anxiety, a feeling of fear are accompanied by pain in the heart area radiating under the left shoulder blade, into the arm, and sometimes into the abdominal area. Neither validol, nor nitroglycerin, nor even promedol relieve pain.

Emergency care consists of calming the patient, reducing pain, oxygen therapy, reflexology with constant monitoring of blood pressure and pulse; it is advisable to administer seduxen (10-20 mg intravenously), as well as a 2% papaverine solution (2 ml) in combination with 1% dibazol (3 -4 ml). It is necessary to call a specialized cardiology team and take an ECG. The patient is transported to a therapeutic clinic or intensive care unit.

Hypertensive crisis- occurs as a result of overwork, overexcitation, pain and psycho-emotional stress of a patient already suffering from hypertension.

Clinically, this is manifested by a sharp increase in blood pressure to 200 mm Hg. Art. and more, headache, tinnitus, redness of the skin of the face, swelling of the saphenous veins, feeling of heat, heavy sweat, shortness of breath. In severe forms, nausea, vomiting, blurred vision, bradycardia, impaired consciousness, even coma occur.

Emergency care consists of correct diagnosis, applying tourniquets to the limbs, applying cold to the back of the head, and calming the patient by administering seduxen (20 mg) in one syringe with baralgin (500 mg) in 10 ml of saline. Then add an injection of dibazole 1% - 3 ml + papaverine 2% - 2 ml; bloodletting up to 300-400 ml is possible (leeches to the occipital region). If the attack does not stop within 30-40 minutes, they resort to the introduction of ganglion-blocking drugs, but this is already the competence of a specialized cardiology team or emergency doctors, who must be called immediately after the crisis occurs. In all cases, the patient must be hospitalized in the clinic.

Vascular, neurocirculatory dystonia- refers to the completely opposite condition of dental patients; characterized by general lethargy, weakness, dizziness, excessive sweating, red dermographism of the skin is pronounced.

With neurocirculatory dystonia of the hypotonic type, functional activity of the cholinergic system and relative insufficiency of the sympathoadrenal system are observed, which determines the development of parasympathetic reactions in the patient under psychoemotional stress.

Emergency care in this category of patients comes down to the use of anticholinergics to avoid circulatory disorders and bronchospasm. Against the background of sedation, intravenous administration of a 0.1% solution of atropine or metacin (0.3 to 1 ml) diluted with saline 1:1 is recommended.

Hypotension- characterized by a decrease in systolic pressure below 100 mmHg. Art., and diastolic - below 60 mm Hg. Art. Primary (essential) hypotension manifests itself as a constitutional hereditary feature of the regulation of vascular tone and is regarded as chronic illness, in which lethargy, drowsiness, a tendency to orthostatic reactions and dizziness are typical symptoms.

Secondary arterial hypotension is observed in long-term oncological diseases, endocrine disorders (hypofunction thyroid gland), diseases of the blood, liver, kidneys and allergies. Clinical manifestations are similar and are aggravated by the factor of emotional stress before dental intervention.

Emergency care for such conditions consists of symptomatic treatment of the most severe functional disorders and the mandatory inclusion in treatment of a benzodiazepine tranquilizer: diazepam (Seduxen, Relanium, Sibazon) at the rate of 0.2 mg/kg of the patient’s body weight in combination with atropine or metacin in an amount of 0.3-1 ml of 1% solution, depending on the initial heart rate and blood pressure data.

Comatose states- are allocated to a separate group of emergency conditions, since their manifestations are observed mainly in patients with concomitant diseases, about which they always need to warn the dentist. Coma is a state of sudden inhibition of higher nervous activity, accompanied by loss of consciousness and disruption of all analyzers. Whom should be distinguished from stupor, when certain elements of consciousness and reaction to strong sound and light stimuli are preserved, and from a state of stupor, or numbness, with symptoms of catatonia, but without loss of consciousness.

There are comas:
from alcohol intoxication;
due to skull trauma (subdural hematoma);
due to poisoning by non-food products, drugs, etc.;
due to infectious meningitis, encephalitis;
uremic;
diabetic;
hypoglycemic;
hypoxic;
for epilepsy.

Provides significant information for the assessment of coma appearance the patient during examination and determination of his condition. Cyanosis and a pronounced pattern of the venous system on the chest and abdomen indicate hepatic hypertension or cirrhosis of the liver, that is, hepatic coma. Hot, dry skin can be due to sepsis, severe infection, or dehydration. Convulsions and rigidity of the neck muscles and facial muscles confirm coma due to increased intracranial pressure (trauma, thrombosis, tumor, etc.).

In the diagnosis of coma, the assessment of breath odor is important: diabetic acidosis as a cause of coma is usually characterized by the odor of acetone from the mouth, a putrid odor indicates hepatic coma, and the odor of urine indicates renal coma. With alcohol intoxication, the smell is typical.

In case of a coma of unknown etiology, it is necessary to examine the blood sugar level.

Emergency care for a coma consists of urgently calling an ambulance or resuscitation team. You should start with constant oxygenation and relief of functional disorders - breathing, blood circulation, heart function and cerebral manifestations. In particular, in case of hypoglycemic coma, it is necessary to immediately administer intravenously 50-60 ml of a 40% glucose solution, since it develops at lightning speed compared to others and is more dangerous in its consequences. The scheme of therapeutic measures for coma is similar to the principles of ABC resuscitation.

Shock manifestations in outpatient dental practice usually occur in the form of an anaphylactic reaction to local anesthetic, antibiotic, sulfa drugs, enzymes and vitamins.

Anaphylactic shock- is an immediate allergic reaction that occurs immediately after parenteral administration of the allergen and is manifested by a feeling of heat, itching in the scalp, extremities, dry mouth, difficulty breathing, redness of the face, followed by pallor, dizziness, loss of consciousness, nausea and vomiting , convulsions, drop in pressure, relaxation, even urinary and fecal incontinence; coma develops.

There are typical forms, cardiac, asthmatic, cerebral and abdominal variants of anaphylactic shock. According to the flow, it is distinguished into lightning, heavy, moderate and light forms.

Severe and lightning forms usually end fatal. In moderate to mild forms, it is possible to identify the above clinical manifestations and carry out treatment.

Emergency care for shock manifestations corresponds to the scheme of resuscitation measures: put the patient in a horizontal position, ensure patency of the upper respiratory tract by turning the patient's head to the side, stretch out the tongue, clear the mouth of mucus and vomit, push the lower jaw forward, begin to artificial respiration.

Intravenously administered antihistamines(2-3 ml of 2% suprastin solution or 2.5% pipolfen solution). Good effect gives the introduction of 3-5 ml of 3% prednisolone solution, 100-120 ml of 5% epsilon-aminocaproic acid. If there are signs of progressive bronchospasm, administration of 10 ml of a 2.4% solution of aminophylline or 2 ml of a 0.5% solution of isadrin is indicated.

To maintain cardiac activity, cardiac glycosides are administered (1-0.5 ml of a 0.06% solution of corglycone in 10 ml of saline), as well as 2-4 ml of a 1% solution of Lasix. This therapy is carried out in combination with mandatory oxygen therapy and breathing compensation.

If there is no improvement in the patient’s condition, the administration of the drugs should be repeated and proceed to drip (from a single system) administration of polyglucin, saline solution with 2-3 ml of dexamethasone added to the bottle at a rate of up to 80 drops per minute. Cardiopulmonary resuscitation is performed according to indications. Patients who have suffered anaphylactic shock should be hospitalized in a special department due to the risk of late complications from the heart, kidneys, and gastrointestinal tract.

It is impossible to avoid such a formidable complication, but it should be prevented by a thorough analysis of the patient’s medical history.

Basics of resuscitation of patients in a dental clinic

During dental intervention, patients may experience critical conditions, accompanied by disruption of the vital functions of the body, which requires the implementation of the necessary resuscitation measures. Resuscitation, or revival of an organism in a state of clinical death, must be performed by a doctor of any specialty. Its basics are included in the concept of ABC resuscitation, that is, the precise implementation of a certain sequence of emergency medical measures and actions. To ensure maximum effectiveness of the activities, you should thoroughly know the individual techniques for their implementation.

When performing artificial respiration, the doctor providing assistance is located at the head of the patient. He brings one hand under back surface neck, the other is placed on the patient’s forehead so that you can pinch his nose with your index finger and thumb and throw back his head. Taking a deep breath, the doctor presses his mouth to the slightly open mouth of the victim and exhales sharply, making sure that the patient’s chest is straightened.

Artificial inhalation can be performed through the nose. Then you should leave the nose free, tightly closing the patient’s mouth with your hand. For hygienic reasons, the patient's mouth (nose) should be covered with a handkerchief or gauze. In recent years, special tubes with biological filters have appeared. Artificial respiration is best done through a Y-shaped tube or an artificial respiration apparatus (such as an Ambu bag).

In the absence of a pulse in the carotid arteries - continuing artificial respiration with a weak, thread-like pulse, the presence of a wide pupil that does not respond to light, and complete relaxation (that is, signs of a terminal condition) - it is urgently necessary to ensure blood circulation by external cardiac massage. The doctor, being on the side of the patient, places the palm of one hand on the lower third of the sternum (two fingers above the xiphoid process, at the place where the ribs attach to the sternum). He holds his second hand on the first at a right angle. Fingers should not touch the chest. An energetic push, allowing the sternum to be shifted towards the spine by 3-4 cm, is used to perform artificial systole. The effectiveness of systole is monitored using the pulse wave on the carotid or femoral artery. Then the doctor relaxes his hands without lifting them from the patient’s chest, which should be horizontal on a hard surface below the level of the doctor’s belt. In this case, for one breath there should be 5-6 massage compressions of the chest, and, consequently, compression of the left ventricle.

Such actions continue until independent heart contractions and pulse appear. carotid artery. After 5-10 minutes of external cardiac massage, if the patient does not regain consciousness, 1 ml of 0.1% adrenaline solution is injected intravenously or sublingually, an ice pack is applied to the head and resuscitation measures are continued until the arrival of a specialized team. Only a resuscitator decides whether to stop resuscitation if it is ineffective.

Principles of cardiopulmonary resuscitation

In all cases:
Place yourself in a horizontal position on a hard surface (couch, floor), call another medical worker or any person for help and call an ambulance.
In the absence of consciousness:
Release tight clothing, throw back your head and extend your lower jaw. If breathing is weakened, let the swab inhale vapors of ammonia, monitor oxygenation, controlling the adequacy of breathing.
If you are not breathing:
Ensure active blowing (through a napkin or handkerchief) of air into the lungs at least 12 times every 1 minute using the mouth-to-mouth, mouth-to-nose method, through an air duct or with a hand-held respirator such as an Ambu bag.
If there is no pulse in the carotid arteries:
Continuing artificial respiration with a weak, thread-like pulse, administer 1 ml of 0.1% atropine solution intravenously from a syringe tube or 0.5 ml of 1% mesatone solution.
With complete absence of pulse and breathing, the presence of a wide pupil that does not respond to light, and complete relaxation, that is, signs of a terminal state, urgently ensure the restoration of blood circulation by indirect massage hearts.
In case of cardiac arrest:
On the bare chest, double arms are placed crosswise in the area of ​​the lower third of the sternum and they push it with pushes, bending it by 3-4 cm. In this case, for one breath there should be 5-6 massage compressions of the chest, and therefore compression of the left ventricle of the heart. Such actions are continued until independent heart contractions and pulse appear in the carotid artery.
After 5-10 minutes of external cardiac massage, if the person does not regain consciousness, 1 ml of 0.1% adrenaline solution is injected intracardially and resuscitation measures are continued until the arrival of a specialized team.

We suggest that practicing dentists use the following proven and new recommendations for the implementation of pain relief in a dental clinic.

Premedication of patients with concomitant diseases

1. For patients with hypertension with a moderate degree of psycho-emotional stress, oral premedication with seduxen at a dose of 0.3 mg/kg of the patient’s body weight is sufficient.
If there is a history of angina pectoris, it is advisable to include baralgin in the premedication at a dose of 30 mg/kg in liquid form from an ampoule.
In case of a pronounced degree of emotional stress according to the ShCS, premedication should be carried out with intravenous administration of seduxen in the same dose, and in the presence of HIHD, it should be combined with baralgin from the same calculation in one syringe.
In case of a pronounced degree of hysterical reaction in patients with hypertension, premedication must be carried out
intravenous administration of the following composition: Seduxen 0.3 mg/kg + Lexir 0.5 mg/kg (or Tramal 50 mg) + 0.1% atropine 0.6 ml. This premedication is performed by an anesthesiologist.
2. For patients with endocrine diseases (mild and moderate degrees of psycho-emotional stress), premedication is mandatory and is performed orally with the tranquilizer Seduxen at a dose of 0.3 mg/kg orally 30-40 minutes before local anesthesia and surgery by the dentist himself.
In patients with diabetes mellitus with a pronounced degree of psycho-emotional stress, premedication is carried out by intravenous administration of seduxen 0.3 mg/kg and baralgin 30 mg/kg in one syringe.
In patients with thyrotoxicosis with a pronounced degree of psycho-emotional stress, it is advisable to use the beta-blocker obzidan (propranolol, 5 ml of 0.1% solution) in a dose of 5 mg at a time in liquid form from an ampoule in combination with seduxen 0.3 mg as premedication /kg of patient's body weight.
In case of a pronounced degree of hysterical reaction in patients with endocrine diseases, premedication is carried out by an anesthesiologist with intravenous administration of seduxen, lexir, atropine in the previously indicated doses.
3. Assessment of psycho-emotional stress according to the ShCS of patients with a history of allergic reactions guides the dentist in choosing pain relief during operations in a dental clinic.
For mild cases, premedication with phenazepam at a dose of 0.01 mg/kg orally in tablets is recommended 30-40 minutes before the intervention.
With a moderate degree of psycho-emotional stress, premedication is also carried out orally with phenazepam at a dose of 0.03 mg/kg in combination with baralgin 30 mg/kg or the beta-blocker obzidan -5 mg at a time from an ampoule in liquid form.
If there is a pronounced degree of psycho-emotional stress in this group of patients, premedication is performed by an anesthesiologist, or general anesthesia is performed.
4. In pregnant women, it is advisable to use the following schemes of combined anesthesia: in patients without concomitant pathology, but with high psychosis emotional stress and a large volume of intervention - the use of Seduxen (Relanium) 0.1-0.2 mg/kg, and in the presence of concomitant pathology in combination with hypotension - Seduxen (Relanium) 0.1-0.2 mg/kg together with baralgin 20- 30 mg/kg.
5. For patients over 60 years of age with mild to moderate levels of psycho-emotional stress, premedication is performed by a dentist: the tranquilizer sibazon is prescribed orally at a dose of 0.2 mg/kg of the patient’s body weight 40 minutes before surgery.
For moderate and severe psycho-emotional stress, premedication consists of a combination of diazepam 0.2 mg/kg and baralgin 30 mg/kg (orally).
In the presence of emotionally caused (paroxysmal) tachycardia, premedication with diazepam (0.2 mg/kg) in combination with the beta-blocker obzidan (5 mg per dose) in liquid form from an ampoule (orally) is indicated.

Modern technologies of local anesthesia

1. For outpatient dental interventions on upper jaw and in the frontal region of the lower jaw
It is recommended to use infiltration anesthesia with drugs based on 4% articaine with adrenaline at a concentration of 1:100000 or 1:200000.
2. To anesthetize premolars in the lower jaw, it is better to use blockade of the mental nerve and the incisive branch of the lower alveolar nerve intraorally, as modified by Malamed, with various amide local anesthetic drugs containing a vasoconstrictor.
3. Anesthesia of mandibular molars is possible using a blockade of the inferior alveolar nerve according to Egorov and Gough-Gates due to safety, technical simplicity and the presence of individual anatomical landmarks.
4. To simplify the technique of blocking the mandibular nerve according to Gou-Gates, it is recommended to use the following manual technique: holding the syringe in right hand, the index finger of the left hand is placed in the external auditory canal or on the skin immediately in front of the lower border of the tragus of the ear at the intertragal notch. Using the sensations of the index finger of the left hand to control the movement of the head of the condylar process onto the articular tubercle during wide opening of the mouth, the neck of the condylar process is determined and the needle is directed to a point in front of the end of the index finger.
5. Increasing the safety of intraligamentary anesthesia is achieved by reducing the number of injection points into the gingival sulcus and the volume of injected anesthetic. To anesthetize a single-rooted tooth, you should make 1 injection of a needle and inject 0.06-0.12 ml of anesthetic solution into the periodontal space, and to anesthetize a two- or three-rooted tooth, 2-3 injections and 0.12-0.36 ml of solution.
6. Small amounts of administered anesthetic and vasoconstrictor when using intraligamentary and intraseptal methods make it possible to recommend them for pain relief in people with cardiovascular, endocrine and other pathologies.
7. In patients who have contraindications to the use of a vasoconstrictor as part of a local anesthetic solution, we recommend using a 3% mepivacaine solution. To potentiate pain relief, we recommend using medication preparation using benzodiazepine tranquilizers.
8. The most convenient and safe for infiltration and conduction anesthesia are foreign spring metal aspiration carpule syringes and the domestic plastic carpule syringe "IS-02 MID", which have a ring stop for the thumb.
9. It seems promising to use a “Wand” computer syringe, which provides precise dosing and slow supply of anesthetic under constant pressure with automation of the aspiration test.
10. We recommend that you determine the diameter and length of the needle, as well as the volume of anesthetic administered, for each method of pain relief individually.

First aid in emergency situations can save a person’s life. Before talking about the types of emergency conditions, you should talk important point, namely the concept of these very states. From the name of the definition it is clear that emergency conditions are those that when a patient urgently needs medical care, waiting for it cannot be delayed even for a second, because then all this can have a detrimental effect on the health, and sometimes even the life of the person.

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

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

All such conditions are difficult to divide into groups; the main feature is a threat to life and urgent medical intervention!

Principles of emergency care

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

First aid

Algorithm of actions for providing first aid in emergency conditions

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

Artificial respiration

How to help children

Children, like adults, have emergency conditions. But the trouble is that children may not notice that something is wrong, and also begin to be capricious, cry, and adults may simply not believe him. This is a great danger, because timely help can save the child’s life, and if his condition suddenly worsens, call the doctor immediately. After all, the child’s body is not yet strong, and the emergency situation should be urgently eliminated.

• First, calm the child so that he does not cry, push, kick, or be afraid of doctors. Describe to the doctor everything that happened as accurately as possible, more details and faster. Tell us what medications he was given and what he ate; perhaps the child had an allergic reaction.
• Before the doctor arrives, prepare antiseptics, clean clothes and fresh air in a room with a comfortable temperature so that the child can breathe well. If you see that the condition is rapidly deteriorating, begin resuscitation measures, cardiac massage, artificial respiration. Also measure the temperature and do not let the child fall asleep until the doctor arrives.
• When the doctor arrives, he will look at the functioning of the internal organs, heart function and pulse. In addition, when making a diagnosis, he will definitely ask how the child behaves, his appetite and usual behavior. Have you had any symptoms previously? Some parents do not tell the doctor everything, for various reasons, but this is strictly forbidden, because he must have a complete picture of your child’s life and activities, so tell everything as detailed and accurately as possible.

First aid standards for emergencies

• Fainting. You need to tilt your head down and keep it in this position in the fresh air, and also bring cotton wool to the patient. ammonia. Provide the patient with peace and quiet, and eliminate sources of stress.
• Bleeding. To prevent blood loss in huge quantities, it needs to be stopped. If this is arterial bleeding, that is, the blood flows like a fountain, it will be more difficult to stop. Apply a tight bandage or tourniquet, and be sure to write down the application time underneath! If this is not done, there is a risk of losing a limb.
• Electric shock. The degree of electric shock may vary, because it depends on the device with which you received a burn and the time of interaction with it. Here, the first thing you need to do is remove the source of the lesion, using a wooden stick. Before the ambulance arrives, you need to check the necessary indicators: pulse, breathing, and consciousness.
• Poisoning. To help a person in case of poisoning, you need to minimize the amount of poison in his body and remove them. Rinse your stomach and intestines, give a laxative, and call an ambulance immediately!

Angina pectoris.

Angina pectoris

Symptoms:

Nurse tactics:

Actions	Rationale
Call a doctor	To provide qualified medical care
Calm and comfortably seat the patient with legs down	Reducing physical and emotional stress, creating comfort
Unbutton tight clothing, ensure airflow fresh air	To improve oxygenation
Measure blood pressure, calculate heart rate	Condition monitoring
Give nitroglycerin 0.5 mg, nitromint aerosol (1 press) under the tongue, repeat the drug if there is no effect after 5 minutes, repeat 3 times under the control of blood pressure and heart rate (BP not lower than 90 mm Hg).	Relieving spasm of the coronary arteries. The effect of nitroglycerin on the coronary vessels begins after 1-3 minutes, the maximum effect of the tablet is at 5 minutes, the duration of action is 15 minutes
Give Corvalol or Valocardin 25-35 drops, or valerian tincture 25 drops	Removing emotional stress.
Place mustard plasters on the heart area	In order to reduce pain, as a distraction.
Give 100% humidified oxygen	Reduced hypoxia
Monitoring pulse and blood pressure.	Condition monitoring
Take an ECG	In order to clarify the diagnosis
Give if pain persists - give a tablet of 0.25 g of aspirin, chew slowly and swallow

1. Syringes and needles for intramuscular and subcutaneous injections.

2. Drugs: analgin, baralgin or tramal, sibazon (seduxen, relanium).

3. Ambu bag, ECG machine.

Assessment of achievements: 1. Complete cessation of pain

2. If the pain persists, if this is the first attack (or attacks within a month), if the primary stereotype of the attack is violated, hospitalization in the cardiology department or intensive care unit is indicated

Note: If a severe headache occurs while taking nitroglycerin, give a validol tablet sublingually, hot sweet tea, nitromint or molsidomine orally.

Acute myocardial infarction

Myocardial infarction- ischemic necrosis of the heart muscle, which develops as a result of disruption of coronary blood flow.

It is characterized by chest pain of unusual intensity, pressing, burning, tearing, radiating to the left (sometimes right) shoulder, forearm, scapula, neck, lower jaw, epigastric region, pain lasts more than 20 minutes (up to several hours, days), can be wavy (it intensifies, then it subsides), or increasing; accompanied by a feeling of fear of death, lack of air. There may be violations heart rate and conductivity, blood pressure instability, taking nitroglycerin does not relieve pain. Objectively: pale skin or cyanosis; cold limbs, cold sticky sweat, general weakness, agitation (the patient underestimates the severity of the condition), motor restlessness, thread-like pulse, may be arrhythmic, frequent or rare, muffled heart sounds, pericardial friction noise, increased temperature.

atypical forms (variants):

Ø asthmatic– attack of suffocation (cardiac asthma, pulmonary edema);

Ø arrhythmic- rhythm disturbances are the only clinical manifestation

or predominate in the clinic;

Ø cerebrovascular- (manifested by fainting, loss of consciousness, sudden death, acute neurological symptoms such as a stroke;

Ø abdominal- pain in the epigastric region, which can radiate to the back; nausea,

vomiting, hiccups, belching, severe bloating, tension in the anterior abdominal wall

and pain on palpation in the epigastric region, Shchetkin’s symptom -

Bloomberg negative;

Ø low-symptomatic (painless) - vague sensations in the chest, unmotivated weakness, increasing shortness of breath, causeless increase in temperature;

Ø with atypical irradiation of pain in – neck, lower jaw, teeth, left arm, shoulder, little finger ( upper - vertebral, laryngeal - pharyngeal)

When assessing the patient’s condition, it is necessary to take into account the presence of risk factors for coronary artery disease, the appearance of pain attacks for the first time or a change in habitual

Nurse tactics:

Actions	Rationale
Call a doctor.	Providing qualified assistance
Observe strict bed rest (place with head elevated), reassure the patient
Provide access to fresh air	In order to reduce hypoxia
Measure blood pressure and pulse	Condition monitoring.
Give nitroglycerin 0.5 mg sublingually (up to 3 tablets) with a 5-minute break if blood pressure is not lower than 90 mm Hg.	Reducing spasm of the coronary arteries, reducing the area of ​​necrosis.
Give an aspirin tablet 0.25 g, chew slowly and swallow	Prevention of blood clots
Give 100% humidified oxygen (2-6L per minute)	Reducing hypoxia
Pulse and blood pressure monitoring	Condition monitoring
Take an ECG	To confirm the diagnosis
Take blood for general and biochemical analysis	to confirm the diagnosis and perform a tropanin test
Connect to heart monitor	To monitor the dynamics of myocardial infarction.

Prepare instruments and preparations:

1. Intravenous system, tourniquet, electrocardiograph, defibrillator, cardiac monitor, Ambu bag.

2. As prescribed by the doctor: analgin 50%, 0.005% fentanyl solution, 0.25% droperidol solution, promedol solution 2% 1-2 ml, morphine 1% IV, Tramal - for adequate pain relief, Relanium, heparin - for the purpose of prevention recurrent blood clots and improvement of microcirculation, lidocaine - lidocaine for the prevention and treatment of arrhythmia;

Hypertensive crisis

Hypertensive crisis - a sudden increase in individual blood pressure, accompanied by cerebral and cardiovascular symptoms (disorder of the cerebral, coronary, renal circulation, autonomic nervous system)

- hyperkinetic (type 1, adrenaline): characterized by a sudden onset, with the appearance of an intense headache, sometimes of a pulsating nature, with a predominant localization in the occipital region, dizziness. Excitement, palpitations, trembling throughout the body, tremors of the hands, dry mouth, tachycardia, increased systolic and pulse pressure. The crisis lasts from several minutes to several hours (3-4). The skin is hyperemic, moist, diuresis is increased at the end of the crisis.

- hypokinetic (2 types, norepinephrine): develops slowly, from 3-4 hours to 4-5 days, headache, “heaviness” in the head, “veil” before the eyes, drowsiness, lethargy, the patient is lethargic, disorientation, “ringing” in the ears, transient disorder vision, paresthesia, nausea, vomiting, pressing pain in the heart, such as angina (pressing), swelling of the face and pasty legs, bradycardia, mainly diastolic pressure increases, pulse decreases. The skin is pale, dry, diuresis is reduced.

Nurse tactics:

Actions	Rationale
Call a doctor.	In order to provide qualified assistance.
Reassure the patient
Maintain strict bed rest, physical and mental rest, remove sound and light stimuli	Reducing physical and emotional stress
Place the head in a high position and turn your head to the side when vomiting.	For the purpose of blood outflow to the periphery, prevention of asphyxia.
Provide access to fresh air or oxygen therapy	In order to reduce hypoxia.
Measure blood pressure, heart rate.	Condition monitoring
Put mustard plasters on calf muscles or apply a heating pad to your legs and arms (you can put your hands in a bath with hot water)	For the purpose of dilating peripheral vessels.
Place a cold compress on your head	To prevent cerebral edema, reduce headaches
Provide intake of Corvalol, motherwort tincture 25-35 drops	Removing emotional stress

Prepare drugs:

Nifedipine (Corinfar) tab. under the tongue, ¼ tab. capoten (captopril) under the tongue, clonidine (clonidine) tab., & anaprilin tab., amp; droperidol (ampoules), furosemide (Lasix tablets, ampoules), diazepam (Relanium, Seduxen), dibazol (amp), magnesium sulfate (amp), aminophylline amp.

Prepare tools:

Device for measuring blood pressure. Syringes, intravenous infusion system, tourniquet.

Assessment of what has been achieved: Reduction of complaints, gradual (over 1-2 hours) decrease in blood pressure to the normal value for the patient

Fainting

Fainting this is a short-term loss of consciousness that develops due to a sharp decrease in blood flow to the brain (several seconds or minutes)

Causes: fear, pain, sight of blood, blood loss, lack of air, hunger, pregnancy, intoxication.

Pre-fainting period: feeling of lightheadedness, weakness, dizziness, darkening of the eyes, nausea, sweating, ringing in the ears, yawning (up to 1-2 minutes)

Fainting: no consciousness, pale skin, decreased muscle tone, cold extremities, rare, shallow breathing, weak pulse, bradycardia, blood pressure - normal or reduced, pupils constricted (1-3-5 minutes, prolonged - up to 20 minutes)

Post-syncope period: consciousness returns, pulse, blood pressure return to normal , Possible weakness and headache (1-2 minutes – several hours). Patients do not remember what happened to them.

Nurse tactics:

Actions	Rationale
Call a doctor.	In order to provide qualified assistance
Lay without a pillow with your legs raised at 20 - 30 0 . Turn your head to the side (to prevent aspiration of vomit)	To prevent hypoxia, improve cerebral circulation
Provide a supply of fresh air or remove it from a stuffy room, give oxygen	To prevent hypoxia
Unbutton tight clothing, pat your cheeks, and splash your face with cold water. Give a cotton swab with ammonia a whiff, rub your body and limbs with your hands.	Reflex effect on vascular tone.
Give tincture of valerian or hawthorn, 15-25 drops, sweet strong tea, coffee
Measure blood pressure, control respiratory rate, pulse	Condition monitoring

Prepare instruments and preparations:

Syringes, needles, cordiamine 25% - 2 ml IM, caffeine solution 10% - 1 ml s/c.

Prepare drugs: aminophylline 2.4% 10 ml IV or atropine 0.1% 1 ml s.c., if fainting is caused by transverse heart block

Assessment of achievements:

1. The patient regained consciousness, his condition improved - consultation with a doctor.

3. The patient’s condition is alarming - call emergency help.

Collapse

Collapse- this is a persistent and long-term decrease in blood pressure due to acute vascular insufficiency.

Causes: pain, injury, massive blood loss, myocardial infarction, infection, intoxication, sudden drop in temperature, change in body position (standing up), standing up after taking antihypertensive drugs and etc.

Ø cardiogenic form - for heart attack, myocarditis, pulmonary embolism

Ø vascular form– for infectious diseases, intoxication, critical decrease in temperature, pneumonia (symptoms develop simultaneously with symptoms of intoxication)

Ø hemorrhagic form - with massive blood loss (symptoms develop several hours after blood loss)

Clinic: the general condition is severe or extremely serious. First, weakness, dizziness, and noise in the head appear. Worried about thirst, chilliness. Consciousness is preserved, but patients are inhibited and indifferent to their surroundings. The skin is pale, moist, cyanotic lips, acrocyanosis, cold extremities. BP less than 80 mm Hg. Art., pulse is frequent, thread-like", breathing is frequent, shallow, heart sounds are muffled, oliguria, body temperature is reduced.

Nurse tactics:

Prepare instruments and preparations:

Syringes, needles, tourniquets, disposable systems

Cordiamine 25% 2ml IM, caffeine solution 10% 1 ml s/c, 1% 1ml mezatone solution,

0.1% 1ml adrenaline solution, 0.2% norepinephrine solution, 60-90 mg prednisolone polyglucin, reopoliglucin, saline.
Assessment of achievements:

1. Condition has improved

2. The condition has not improved - be prepared for CPR

Shock - a condition in which there is a sharp, progressive decrease in all vital functions of the body.

Cardiogenic shock develops as a complication of acute myocardial infarction.
Clinic: a patient with acute myocardial infarction develops severe weakness, skin
pale, moist, “marbled”, cold to the touch, collapsed veins, cold hands and feet, pain. Blood pressure is low, systolic about 90 mm Hg. Art. and below. The pulse is weak, frequent, “thread-like”. Breathing is shallow, frequent, oliguria

Ø reflex form (pain collapse)

Ø true cardiogenic shock

Ø arrhythmic shock

Nurse tactics:

Prepare instruments and preparations:

Syringes, needles, tourniquet, disposable systems, cardiac monitor, ECG machine, defibrillator, Ambu bag

0.2% norepinephrine solution, mezaton 1% 0.5 ml, saline. solution, prednisolone 60 mg, reopo-

liglucin, dopamine, heparin 10,000 units IV, lidocaine 100 mg, narcotic analgesics (Promedol 2% 2ml)
Assessment of achievements:

The condition has not worsened

Bronchial asthma

Bronchial asthma - chronic inflammatory process in the bronchi, predominantly of an allergic nature, the main clinical symptom is an attack of suffocation (bronchospasm).

During an attack: a spasm of the smooth muscles of the bronchi develops; - swelling of the bronchial mucosa; formation of viscous, thick, mucous sputum in the bronchi.

Clinic: the appearance of attacks or their increase in frequency are preceded by exacerbations inflammatory processes in the bronchopulmonary system, contact with an allergen, stress, meteorological factors. The attack develops at any time of the day, most often at night in the morning. The patient develops a feeling of “lack of air”, he takes a forced position with support on his hands, expiratory shortness of breath, unproductive cough, auxiliary muscles are involved in the act of breathing; There is retraction of the intercostal spaces, retraction of the supra-subclavian fossae, diffuse cyanosis, a puffy face, viscous sputum, difficult to separate, noisy, wheezing breathing, dry wheezing, audible at a distance (remote), boxy percussion sound, rapid, weak pulse. In the lungs - weakened breathing, dry wheezing.

Nurse tactics:

Actions	Rationale
Call a doctor	The condition requires medical attention
Reassure the patient	Reduce emotional stress
If possible, find out the allergen and separate the patient from it	Termination of exposure causative factor
Sit down with emphasis on your hands, unfasten tight clothing (belt, trousers)	To make breathing easier heart.
Provide fresh air flow	To reduce hypoxia
Offer to hold your breath voluntarily	Reducing bronchospasm
Measure blood pressure, calculate pulse, respiratory rate	Condition monitoring
Help the patient use a pocket inhaler, which the patient usually uses no more than 3 times per hour, 8 times a day (1-2 puffs of Ventolin N, Berotek N, Salbutomol N, Bekotod), which the patient usually uses, if possible, use a metered-dose inhaler with spencer, use nebulizer	Reducing bronchospasm
Give 30-40% humidified oxygen (4-6l per minute)	Reduce hypoxia
Give a warm fractional alkaline drink (warm tea with soda on the tip of a knife).	For better sputum removal
If possible, make hot foot and hand baths (40-45 degrees, pour water into a bucket for the feet and a basin for the hands).	To reduce bronchospasm.
Monitor breathing, cough, sputum, pulse, respiratory rate	Condition monitoring

Features of the use of freon-free inhalers (N) - the first dose is released into the atmosphere (these are alcohol vapors that have evaporated in the inhaler).

Prepare instruments and preparations:

Syringes, needles, tourniquet, intravenous infusion system

Medicines: 2.4% 10 ml aminophylline solution, prednisolone 30-60 mg mg IM, IV, saline solution, adrenaline 0.1% - 0.5 ml s.c., suprastin 2% -2 ml, ephedrine 5% - 1 ml.

Assessment of what has been achieved:

1. Choking has decreased or stopped, sputum is released freely.

2. The condition has not improved - continue the measures taken until the ambulance arrives.

3. Contraindicated: morphine, promedol, pipolfen - they depress breathing

Pulmonary hemorrhage

Causes: chronic lung diseases (EBD, abscess, tuberculosis, lung cancer, emphysema)

Clinic: cough with the release of scarlet sputum with air bubbles, shortness of breath, possible pain when breathing, decreased blood pressure, pale, moist skin, tachycardia.

Nurse tactics:

Prepare instruments and preparations:

Everything you need to determine your blood type.

2. Calcium chloride 10% 10ml i.v., vikasol 1%, dicinone (sodium etamsylate), 12.5% ​​-2 ml i.m., i.v., aminocaproic acid 5% i.v. drops, polyglucin, rheopolyglucin

Assessment of achievements:

Reducing cough, reducing the amount of blood in sputum, stabilizing pulse, blood pressure.

Hepatic colic

Clinic: intense pain in the right hypochondrium, epigastric region (stabbing, cutting, tearing) with irradiation to the right subscapular region, shoulder blade, right shoulder, collarbone, neck area, jaw. Patients rush about, moan, and scream. The attack is accompanied by nausea, vomiting (often mixed with bile), a feeling of bitterness and dry mouth, and bloating. The pain intensifies with inspiration, palpation of the gallbladder, positive Ortner's sign, possible subictericity of the sclera, darkening of the urine, increased temperature

Nurse tactics:

Prepare instruments and preparations:

1. Syringes, needles, tourniquet, intravenous infusion system

2. Antispasmodics: papaverine 2% 2 - 4 ml, but - spa 2% 2 - 4 ml intramuscularly, platiphylline 0.2% 1 ml subcutaneously, intramuscularly. Non-narcotic analgesics: analgin 50% 2-4 ml, baralgin 5 ml IV. Narcotic analgesics: promedol 1% 1 ml or omnopon 2% 1 ml i.v.

Morphine should not be administered - it causes spasm of the sphincter of Oddi

Renal colic

It occurs suddenly: after physical exertion, walking, bumpy driving, or drinking copious amounts of fluid.

Clinic: sharp, cutting, unbearable pain in the lumbar region, radiating along the ureter to the iliac region, groin, inner thigh, external genitalia, lasting from several minutes to several days. Patients are tossing about in bed, moaning, screaming. Dysuria, pollakiuria, hematuria, sometimes anuria. Nausea, vomiting, fever. Reflex intestinal paresis, constipation, reflex pain in the heart.

Upon inspection: asymmetry of the lumbar region, pain on palpation along the ureter, positive Pasternatsky's sign, tension in the muscles of the anterior abdominal wall.

Nurse tactics:

Prepare instruments and preparations:

1. Syringes, needles, tourniquet, intravenous infusion system

2. Antispasmodics: papaverine 2% 2 - 4 ml, but - spa 2% 2 - 4 ml intramuscularly, platiphylline 0.2% 1 ml subcutaneously, intramuscularly.

Non-narcotic analgesics: analgin 50% 2-4 ml, baralgin 5 ml IV. Narcotic analgesics: promedol 1% 1 ml or omnopon 2% 1 ml i.v.

Anaphylactic shock.

Anaphylactic shock- this is the most dangerous clinical variant of an allergic reaction that occurs when administered various substances. Anaphylactic shock can develop if it enters the body:

a) foreign proteins (immune sera, vaccines, organ extracts, poisons);

insects...);

b) medications (antibiotics, sulfonamides, B vitamins...);

c) other allergens (plant pollen, microbes, food products: eggs, milk,

fish, soy, mushrooms, tangerines, bananas...

d) with insect bites, especially bees;

e) in contact with latex (gloves, catheters, etc.).

Ø lightning form develops 1-2 minutes after administration of the drug -

characterized by rapid development clinical picture acute ineffective heart, without resuscitation it ends tragically in the next 10 minutes. Symptoms are scanty: severe pallor or cyanosis; dilated pupils, lack of pulse and pressure; agonal breathing; clinical death.

Ø moderate shock, develops 5-7 minutes after drug administration

Ø severe form, develops within 10-15 minutes, maybe 30 minutes after administration of the drug.

Most often, shock develops within the first five minutes after the injection. Food shock develops within 2 hours.

Clinical variants of anaphylactic shock:

1. Typical shape: feeling of heat “swept with nettles”, fear of death, severe weakness, tingling, itching of the skin, face, head, hands; a feeling of a rush of blood to the head, tongue, heaviness behind the sternum or compression of the chest; pain in the heart, headache, difficulty breathing, dizziness, nausea, vomiting. In the fulminant form, patients do not have time to make complaints before losing consciousness.
2. Cardiac option manifests itself as signs of acute vascular insufficiency: severe weakness, pale skin, cold sweat, “thready” pulse, blood pressure drops sharply, in severe cases consciousness and breathing are depressed.
3. Asthmoid or asphyxial variant manifests itself as signs of acute respiratory failure, which is based on bronchospasm or swelling of the pharynx and larynx; chest tightness, coughing, shortness of breath, and cyanosis appear.
4. Cerebral variant manifests itself as signs of severe cerebral hypoxia, convulsions, foaming from the mouth, involuntary urination and defecation.

5. Abdominal option manifested by nausea, vomiting, paroxysmal pain in the
stomach, diarrhea.

Hives appear on the skin, in some places the rashes merge and turn into dense pale swelling - Quincke's edema.

Nurse tactics:

Actions	Rationale
Ensure that a doctor is called through an intermediary. The patient is not transportable, assistance is provided on the spot
If anaphylactic shock develops due to intravenous administration of a drug
Stop drug administration, maintain venous access	Reducing the allergen dose
Give a stable lateral position, or turn your head to the side, remove the dentures
Raise the foot end of the bed.	Improving blood supply to the brain, increasing blood flow to the brain
	Reduced hypoxia
Measure blood pressure and heart rate	Condition monitoring.
For intramuscular administration: stop administering the drug by first pulling the piston towards you. If an insect bites, remove the sting;	In order to reduce the administered dose.
Provide intravenous access	For administering drugs
Give a stable lateral position or turn your head to the side, remove the dentures	Prevention of asphyxia with vomit, tongue retraction
Raise the foot end of the bed	Improving blood supply to the brain
Access to fresh air, give 100% humidified oxygen, no more than 30 minutes.	Reduced hypoxia
Apply cold (ice pack) to the injection or bite area or apply a tourniquet above	Slowing down the absorption of the drug
Apply 0.2 - 0.3 ml of 0.1% adrenaline solution to the injection site, diluting them in 5-10 ml of saline. solution (diluted 1:10)	In order to reduce the rate of absorption of the allergen
In case of an allergic reaction to penicillin, bicillin, administer penicillinase 1,000,000 units intramuscularly
Monitor the patient’s condition (BP, respiratory rate, pulse)

Prepare instruments and preparations:

tourniquet, ventilator, tracheal intubation kit, Ambu bag.

2. Standard set of drugs “Anaphylactic shock” (0.1% adrenaline solution, 0.2% norepinephrine, 1% mezatone solution, prednisolone, 2% suprastin solution, 0.05% strophanthin solution, 2.4% aminophylline solution, saline . solution, albumin solution)

Medical assistance for anaphylactic shock without a doctor:

1. Intravenous administration of adrenaline 0.1% - 0.5 ml per physical session. r-re.

After 10 minutes, the injection of adrenaline can be repeated.

In the absence of venous access, adrenaline
0.1% -0.5 ml can be injected into the root of the tongue or intramuscularly.

Actions:

Ø adrenaline increases heart contractions, increases heart rate, constricts blood vessels and thus increases blood pressure;

Ø adrenaline relieves spasm of bronchial smooth muscles;

Ø adrenaline slows down the release of histamine from mast cells, i.e. fights allergic reactions.

2. Provide intravenous access and begin fluid administration (physiological

solution for adults > 1 liter, for children - at the rate of 20 ml per kg) - replenish the volume

fluid in the vessels and increase blood pressure.

3. Administration of prednisolone 90-120 mg IV.

As prescribed by a doctor:

4. After stabilization of blood pressure (BP above 90 mm Hg) - antihistamines:

5. For bronchospastic form, aminophylline 2.4% - 10 i.v. In saline solution. When on-
in the presence of cyanosis, dry wheezing, oxygen therapy. Possible inhalations

alupenta

6. For convulsions and severe agitation - IV sedeuxene

7. For pulmonary edema - diuretics (Lasix, furosemide), cardiac glycosides (strophanthin,

korglykon)

After recovery from shock, the patient is hospitalized for 10-12 days.

Assessment of achievements:

1. Stabilization of blood pressure and heart rate.

2. Restoration of consciousness.

Urticaria, Quincke's edema

Hives: allergic disease , characterized by a rash of itchy blisters on the skin (swelling of the papillary layer of the skin) and erythema.

Causes: medicines, serums, food products...

The disease begins with an unbearable skin itching on various parts of the body, sometimes on the entire surface of the body (on the trunk, limbs, sometimes palms and soles of the feet). Blisters protrude above the surface of the body, from pinpoint sizes to very large ones; they merge, forming elements of different shapes with uneven, clear edges. The rash may persist in one place for several hours, then disappear and reappear in another place.

There may be fever (38 - 39 0), headache, weakness. If the disease lasts more than 5-6 weeks, it becomes chronic and is characterized by an undulating course.

Treatment: hospitalization, withdrawal medicines(stop contact with the allergen), fasting, repeated cleansing enemas, saline laxatives, Activated carbon, polypefan inside.

Antihistamines: diphenhydramine, suprastin, tavigil, fenkarol, ketotefen, diazolin, telfast...orally or parenterally

To reduce itching - intravenous solution of sodium thiosulfate 30% -10 ml.

Hypoallergenic diet. Make a note on the title page of the outpatient card.

Conversation with the patient about the dangers of self-medication; when applying for honey. With this help, the patient must warn the medical staff about drug intolerance.

Quincke's edema- characterized by swelling of the deep subcutaneous layers in places with loose subcutaneous tissue and on the mucous membranes (when pressed, no pit remains): on the eyelids, lips, cheeks, genitals, back of the hands or feet, mucous membranes of the tongue, soft palate, tonsils, nasopharynx, gastrointestinal tract (clinic acute abdomen). If the larynx is involved in the process, asphyxia may develop (restlessness, puffiness of the face and neck, increasing hoarseness, “barking” cough, difficult stridor breathing, lack of air, cyanosis of the face); with swelling in the head area, the meninges are involved in the process (meningeal symptoms) .

Nurse tactics:

Actions	Rationale
Ensure that a doctor is called through an intermediary. Stop contact with the allergen	To determine further tactics for providing medical care
Reassure the patient	Relieving emotional and physical stress
Find the sting and remove it along with the poisonous sac	In order to reduce the spread of poison in tissues;
Apply cold to the bite site	A measure to prevent the spread of poison in tissue
Provide access to fresh air. Give 100% humidified oxygen	Reducing hypoxia
Put it in your nose vasoconstrictor drops(naphthyzin, sanorin, glazolin)	Reduce swelling of the mucous membrane of the nasopharynx, make breathing easier
Pulse control, blood pressure, respiratory rate	Pulse control, blood pressure, respiratory rate
Give cordiamine 20-25 drops	To maintain cardiovascular activity

Prepare instruments and preparations:

1. System for intravenous infusion, syringes and needles for IM and SC injections,
tourniquet, ventilator, tracheal intubation kit, Dufault needle, laryngoscope, Ambu bag.

2. Adrenaline 0.1% 0.5 ml, prednisolone 30-60 mg; antihistamines 2% - 2 ml of suprastin solution, pipolfen 2.5% - 1 ml, diphenhydramine 1% - 1 ml; fast-acting diuretics: lasix 40-60 mg IV in a stream, mannitol 30-60 mg IV in a drip

Inhalers salbutamol, alupent

3. Hospitalization in the ENT department

First aid for emergencies and acute diseases

Angina pectoris.

Angina pectoris- this is one of the forms of coronary artery disease, the causes of which can be: spasm, atherosclerosis, transient thrombosis of the coronary vessels.

Symptoms: paroxysmal, squeezing or pressing pain behind the sternum, exercise lasting up to 10 minutes (sometimes up to 20 minutes), which goes away when the exercise stops or after taking nitroglycerin. The pain radiates to the left (sometimes right) shoulder, forearm, hand, shoulder blade, neck, lower jaw, epigastric region. It may manifest itself as atypical sensations such as lack of air, difficult-to-explain sensations, or stabbing pains.

Nurse tactics: