What to do with a collapsed lung. First aid for collapse. What is collapse

Collapse is observed in various pathological conditions and is characterized by insufficient blood supply tissues (decrease in tissue perfusion) with dysfunction of vital important organs. In such a situation, it is necessary to take urgent resuscitation measures, otherwise you can lose the patient. In our article, we will consider what emergency care should be in case of collapse, what to do in similar situation and what are possible reasons a similar state.

Reasons for the development of collapse

Disturbances in the blood supply to tissues and organs and their function occur as a result of collapse - acute vascular insufficiency with a drop in vascular tone, a decrease in the contractile function of the heart and a decrease in the volume of circulating blood. Distinguish:

• traumatic collapse (due to severe injuries),
• hemorrhagic (due to blood loss),
• burn,
• cardiogenic (due to myocardial damage),
• infectious-toxic,
• anaphylactic collapse, etc.

Taking into account the fundamental pathogenetic mechanism for the development of shock, there are also

• hypovolemic collapse (due to a decrease in circulating blood volume),
• cardiogenic (due to dysfunction of the heart and decrease in cardiac output),
• vascular, (caused by decreased vascular tone)
• and mixed collapse (with a combination of these causes).

At the same time, it is important to remember that with a collapse of any nature, it is hypovolemia that is the main link in pathogenesis, which determines medical tactics and help with collapse.

Causes of hypovolemic collapse

The cause of the disease may be acute external and / or internal bleeding as a result of injury or disease, loss of plasma during thermal burns. A similar mechanism is observed during collapse due to uncompensated fluid loss with profuse vomiting and diarrhea, with insipidus and diabetes etc. A sudden decrease in circulating blood volume due to loss of blood, plasma or body fluids leads to a decrease in venous return to the heart, a decrease in cardiac output and a decrease in blood pressure, which, as you know, depends on the minute volume of the heart and the value of peripheral resistance.

The activation of the sympathoadrenal system that occurs with symptoms of hypovolemic collapse is defensive reaction organism, aimed at maintaining the constancy of blood pressure. At the same time, tachycardia develops due to stimulation of beta-receptors of the heart and vasoconstriction due to stimulation of alpha-adrenergic receptors of the vessels of the kidneys, lungs, liver, skin, and muscles. Supported by centralization normal blood flow in the vessels of the heart and brain. However, if vasoconstriction persists, the decrease in tissue perfusion leads to irreversible damage to the cells of the ischemic organs.

Causes of cardiogenic collapse

Cardiogenic collapse develops due to a decrease in myocardial contractility (most often with acute infarction myocardium, less often - with myocarditis or poisoning with cardiotoxic substances), with severe tachycardia and bradycardia, as well as with morphological disorders (rupture interventricular septum, acute valvular insufficiency, critical aortic stenosis).

Insufficient filling of the heart cavities may be based on pericardial tamponade, pulmonary embolism, tension pneumothorax (obstructive shock). All these factors lead to a decrease in the minute volume of the heart, depending on its mechanical pumping function, heart rate (HR), filling of the heart cavities and the function of the heart valves. A decrease in cardiac output and a drop in blood pressure lead to activation of the sympathoadrenal system and centralization of blood flow.

Causes of vascular collapse

The pathogenesis of vascular collapse is based on relative hypovolemia - the normal volume of circulating blood is insufficient to adequately fill the ventricular cavities. With an infectious-toxic (septic) collapse under the influence of bacterial toxins, oxygen uptake by tissues decreases and arteriovenous shunts open, peripheral resistance decreases, as a result of which blood pressure falls. In order to maintain normal level The body reacts to blood pressure with a hyperdynamic circulation reaction - an increase in stroke volume and heart rate. In the future, an increase in the permeability of the capillary wall, deposition of blood and an increasing decrease in the volume of circulating blood with a decrease in venous return to the heart, as well as the development of heart failure lead to the manifestation of the hypodynamic stage septic shock.

In anaphylactic collapse, relative hypovolemia is due to the vasodilating effect of histamine and other mediators of allergy, as well as an increase in capillary permeability under their influence. The accumulation of blood in the capillaries and veins leads to a decrease in venous return and a decrease in the stroke volume of the heart, a drop in blood pressure and a decrease in capillary perfusion.

How to provide emergency assistance in case of collapse?

Emergency care must comply with the requirements of emergency therapy, i.e., funds should be immediately applied that give an effect immediately after their introduction. Delay in the treatment of such a patient can lead to the development of severe microcirculation disorders, the appearance of irreversible changes in tissues and be the direct cause of the patient's death. Since in the mechanism of shock development essential role play a decrease in vascular tone and a decrease in blood flow to the heart, therapeutic measures first of all, should be aimed at increasing venous and arterial tone and increasing the volume of fluid in bloodstream.

First of all, the patient is laid horizontally, that is, without a high pillow (sometimes with raised legs) and oxygen therapy is provided. The head should be turned to the side to avoid aspiration of vomit in case of vomiting.

Preparations for emergency care at the beginning of the collapse

Reception medicines through the mouth with symptoms of collapse, of course, is meaningless. In collapse, only intravenous infusion of drugs may be of benefit, as a disorder of tissue circulation impairs absorption. medicinal substances administered subcutaneously or intramuscularly, as well as taken orally.

As an emergency, rapid infusion of fluids that increase the volume of circulating blood is shown: colloidal (for example, polyglucin) and saline solutions to increase blood pressure to 100 mm Hg. Art. Isotonic sodium chloride solution is quite suitable as an emergency aid for collapse, but when transfusing very large volumes, pulmonary edema may develop. In the absence of signs of heart failure, the first portion of isotonic sodium chloride solution (400 ml) is administered by jet. If shock is caused by acute blood loss not exceeding 30% of its total volume, the same therapy is carried out; with greater blood loss, if possible, blood is transfused or blood-substituting fluids are administered.

With cardiogenic collapse, this cannot be done due to the danger of pulmonary edema. Preference is given to pressor amines. In anaphylactic collapse and shock resistant to fluids (unless there are signs of ongoing internal bleeding), therapy with pressor amines is also indicated.

Alpha-adrenergic agonist Norepinephrine acts not only on blood vessels, but also on the heart, having positive ino- and chronotropic effects (strengthens and speeds up heart contractions). Norepinephrine is injected intravenously at a rate of 1-8 µg/kg/min. In the absence of a dispenser, they act as follows: 150–200 ml of 5% glucose solution or isotonic sodium chloride solution with 1–2 ml of 0.2% norepinephrine solution are poured into the dropper and the clamp is set so that the injection rate is 16–20 drops per minute. Checking blood pressure every 10-15 minutes, if necessary, double the rate of administration. If interruption for 2 to 3 minutes (with a clamp) of the drug does not cause a second drop in pressure, you can stop the infusion while continuing to control the pressure.

Dopamine as an emergency aid for collapse has a selective vascular effect. It causes vasoconstriction of the skin and muscles, but dilates the vessels of the kidneys and internal organs. Dopamine is administered by intravenous drip at an initial rate of 200 µg/min. In the absence of a dispenser, it can be used following diagram: 200 mg of dopamine is diluted in 400 ml of isotonic sodium chloride solution, the initial rate of administration is 10 drops per minute, if there is no effect, the rate of administration is gradually increased to 30 drops per minute under the control of blood pressure and diuresis.

Additional emergency measures for collapse

Since shock can be caused various reasons, along with the introduction of fluids and vasoconstrictors measures are needed to prevent the further impact of these causal factors and development pathogenetic mechanisms leading to hypovolemia. For tachyarrhythmias, the drug of choice is electropulse therapy, with bradycardia - electrical stimulation of the heart. In true cardiogenic shock, it is sometimes possible to improve the prognosis by timely systemic thrombolysis.

What to do when different types collapse?

In emergency care for hemorrhagic collapse, measures to stop bleeding (tourniquets, tight bandages, tamponade, etc.) come to the fore. Pathogenetic treatment is thrombolysis in thromboembolism of the branches pulmonary artery, drainage pleural cavity with tension pneumothorax, pericardiocentesis with pericardial tamponade. Pericardial puncture may be complicated by myocardial injury or coronary arteries with the development of hemopericardium and fatal arrhythmias, therefore, in the presence of absolute indications, this procedure can only be performed qualified specialist in a hospital setting.

As an emergency for hemorrhagic collapse, it is indicated local anesthesia (novocaine blockades site of injury). In traumatic, burn shock, when adrenal insufficiency occurs due to stress, it is necessary to use prednisolone, hydrocortisone.

What to do with infectious-toxic collapse. Antibiotics are prescribed for emergency care.

As an emergency for anaphylactic collapse, the volume of circulating blood is also replenished with saline or colloidal solutions (500-1000 ml), but the main treatment is Adrenaline at a dose of 0.3-0.5 mg subcutaneously with repeated injections every 20 minutes, additionally used glucocorticoids (intravenous hydrocortisone or prednisolone, or betamethasone).

As an emergency treatment for hemolytic collapse (due to transfusion of incompatible blood), therapy includes the introduction alkaline solutions and early stimulation of diuresis to prevent naturally complicating hemolysis of acute renal failure.

All medical measures are carried out against the background of absolute rest for the patient, who is laid with a low head position. The patient is subject to emergency hospitalization in the intensive care unit multidisciplinary hospital or specialized department. Transportation of the patient is carried out, if possible, by a specialized ambulance, in which all necessary medical measures are continued.

Clinical picture of collapse

The clinical picture of shock is due to a critical decrease in capillary blood flow in the affected organs. Draws attention on examination characteristic face a patient in shock. It is also described by Hippocrates (Hippocratic mask): “... The nose is sharp, the eyes are sunken, the temples are depressed, the ears are cold and tight, the earlobes are turned, the skin on the forehead is hard, stretched and dry, the color of the whole face is green, black or pale, or lead". Along with the noted signs (a haggard earthy face, sunken eyes, pallor or cyanosis), the low position of the patient in bed, immobility and indifference to the environment, barely audible, "reluctant" answers to questions attract attention. Patients complain about severe weakness, dizziness, chilliness, blurred vision, tinnitus, sometimes a feeling of melancholy and fear. Often drops of cold sweat appear on the skin, the limbs are cold to the touch, with a cyanotic skin tone (the so-called peripheral signs of shock). Breathing is usually rapid, shallow, with depression of the function of the respiratory center due to increasing hypoxia of the brain, apnea is possible. There is oliguria (less than 20 ml of urine per hour) or anuria.

Biggest changes during collapse are observed from the side of cardio-vascular system: pulse is very frequent, weak content and tension ("filamentous"). AT severe cases can't feel it. The most important diagnostic feature and the most accurate indicator of the severity of the patient's condition is a drop in blood pressure. Both the maximum and minimum, and pulse pressure are reduced. We can talk about shock with a decrease systolic pressure below 90 mm Hg. Art. (later it decreases to 50 - 40 mm Hg or is not even detected when measured with a cuff); diastolic blood pressure drops to 40 mm Hg. Art. and below. In individuals with previous arterial hypertension the picture of collapse can be observed even at more high rates HELL. A steady increase in blood pressure with repeated measurements indicates the effectiveness of the ongoing emergency care in case of collapse.

Features of the course of collapse

With hypovolemic and cardiogenic collapse, all the described signs are sufficiently pronounced. In hypovolemic shock, unlike cardiogenic shock, there are no swollen, pulsating jugular veins. On the contrary, the veins are empty, collapsed, to receive blood during puncture cubital vein difficult and sometimes impossible. If you raise the patient's hand, you can see how they immediately fall saphenous veins. If you then lower your hand so that it hangs down from the bed, the veins fill very slowly.

With cardiogenic collapse neck veins are filled with blood, signs of pulmonary stagnation come to light. With an infectious-toxic collapse, the clinical features are fever with amazing chills, warm, dry skin, and in advanced cases, strictly defined skin necrosis with its rejection in the form of blisters, petechial hemorrhages and pronounced marbling of the skin.

With anaphylactic collapse, in addition to circulatory symptoms, other manifestations of anaphylaxis are noted, in particular:

skin and respiratory symptoms(itching, erythema, urticaria, angioedema, bronchospasm, stridor),

abdominal pain.

Distinctive feature anaphylactic collapse, which develops as a result of a total expansion of the arteries, including the skin - warm skin.

Collapse Diagnostics

The diagnosis of collapse is made on the basis of a characteristic clinic. diagnostic criteria are a drop in blood pressure, apathy and drowsiness, pallor, cyanosis, marble coloration of the skin, their high humidity, cold extremities, respiratory disorders (dyspnea), oliguria.

The differential diagnosis of collapse is with acute heart failure. Distinguishing features include:

position of the patient in bed (low in shock and semi-sitting in heart failure),

his appearance(with shock, a hippocratic mask, pallor, marbling of the skin or gray cyanosis, with heart failure - more often a cyanotic puffy face, swollen pulsating veins, acrocyanosis),

breathing (with shock it is rapid, shallow, with heart failure - rapid and increased, often difficult),

expansion of the boundaries of cardiac dullness and signs of cardiac stagnation (moist rales in the lungs, enlargement and tenderness of the liver) in heart failure and a sharp drop in blood pressure during shock.

With this disease, vascular tone drops sharply, so the cells receive much less blood. Emergency care for a collapse is provided immediately, since if the necessary actions are not taken, death may occur due to insufficient oxygen supplied to the brain.

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

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

1. A sudden and sharp deterioration in a person's well-being, while external prerequisites for this phenomenon could not be observed.
2. The appearance of an unreasonable and very intense headache.
3. The darkness before the eyes of the patient is expressed by a strong expansion of his pupils.
4. A person notices the appearance of tinnitus.
5. Pain in the region of the heart. Moderate discomfort may occur.
6. Severe weakness, often loss of orientation in space. This condition differs from fainting, because even when a person comes to himself, he does not have the strength to rise quickly.
7. downgrade blood pressure.
8. The skin turns pale. This phenomenon occurs as quickly as the appearance of other signs of collapse. After a few minutes without assistance skin get very wet and cold. Then they turn blue.
9. There is a sharpening of facial features.
10. Breathing changes. It becomes very frequent, while its sound is clearly audible, since it is carried out at an impetuous pace.
11. It is very difficult to feel the patient's pulse.
12. Often a person loses consciousness for a long time, without rehabilitation measures he may not come to his senses.

First aid

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

If not fulfill right action, negative state most likely to end in death. When completing all the points, it must be remembered that any delay has a detrimental effect on the patient, so help should be provided quickly and decisively.

If a person collapses in a crowded place and it is inconvenient to provide first aid, it is necessary to place him correctly. The patient is located in lying position. It must be laid on its back and ensure balance. It is advisable to choose a hard surface without protrusions so as not to injure a person.

It is not advisable to transfer the patient to the bed, since its softness will interfere with the implementation further action. If nothing even was found, you can put a person on the floor, after covering the surface with a cloth. The head should be slightly bent. You can put a small pillow or other soft thing under it. Legs should be raised and fixed in this position. You can put a bundle of some material under them by rolling up a volumetric roller. If there are no suitable things, one of those present can independently hold their legs in an elevated position.

Checklist of necessary actions

1. Emergency care for collapse requires that everything that can compress the patient's body, prevent breathing calmly, must be removed or unfastened. It is necessary to remove the belt, unbutton the cuffs, as well as the collar. You can take off as many clothes as possible, but you should do it all quickly.
2. Someone needs to call an ambulance while emergency care is being taken for the collapse. If among those present there is a doctor or a person with experience in providing first aid, it is necessary that he is the one who is engaged in rehabilitation measures. If a person who is able to provide assistance is alone, then it is advisable to call in parallel ambulance and keep doing necessary measures upon the return of consciousness to the patient.
3. There should be a lot in the room fresh air. A window should be opened. If possible, perform oxygen inhalation.
4. The patient is useful heat. Before the arrival of doctors, it is necessary, if possible, to make the air in the room warm with a heater, to overlay the patient with heating pads on all sides of the body.
5. It is brought to the nose of a person. This can bring him to consciousness. If a this tool not available, you can perform other actions aimed at enhancing the activity of the brain. This is a massage of both earlobes, temples, as well as the area where the depression is located above upper lip.

Features of the assistance process

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

Prohibited actions

1. When emergency care is provided for collapse, you should not offer the patient to drink painkillers or take any medications that affect vasodilation. This may lead to sad consequences and even to lethal outcome.
2. Attempt to mechanically push fluid or any medical preparations if he sleeps, you can't. If the attempt fails, reflex respiratory arrest may occur.
3. To slap a person, bringing him to consciousness. Often these actions do not improve the situation, but only increase the patient's stress.

Appropriateness of medications for collapse

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

Essential medicines for collapse

Usually produced first intravenous infusion using drugs such as sodium chloride or Ringer's solution. There is no fixed amount assigned. When determining the dose should be guided outward signs patient:

1. The general condition of a person, a set of indicators that determine the viability and prognosis of the disease.
2. Skin tone. Especially important is the complexion, in particular the nasolabial triangle. It should not be too pale. If the color is close to white, more vasodilator solution will be needed.
3. Absence or presence of diuresis.
4. Arterial pressure.
5. The frequency of heart beats, as well as the intensity of the pulse in different parts body.

Additional drugs

1. You need anti-inflammatory drugs. With collapse, it is desirable to administer such agents: Metipred, Triamcinolone or Prednisolone.
2. You can also enter vasopressors intravenously.
3. The spasm should be relieved quickly. To do this, you can enter even the usual solution of novocaine. If it is more convenient to inject intramuscularly, it is advisable to use Aminazin.

An emergency in case of collapse is necessary, since not always an ambulance can get quickly. To be able to provide real help a person should memorize a set of instructions and, if necessary, accurately execute it. Often assisting in the event of a collapse is the only way through which a person's life is saved.

Collapse is one of the forms of vascular insufficiency that occurs in acute form. At the same time, the general tone of all the vessels of the body drops sharply due to sharp decline volume of blood that circulates in the human body. This is very dangerous state, which can be fatal, in connection with these circumstances, emergency care for collapse should be provided as quickly as possible. The patient's death may occur in as soon as possible, since the brain does not receive oxygen in the amount necessary for its vital activity.

Emergency aid for collapse has a specific algorithm of actions, however, it is quite simple, and it will not be difficult to remember it. But before proceeding to its study, it is necessary to understand in more detail what a collapse is, what causes it can cause and how to distinguish it from other attacks.

The human body is a very complex, but well-functioning mechanism. When failures occur in this mechanism, a person has various diseases, and each of them has its own symptoms and features of the course. In order to provide the right help a person needs to know the clinical picture and signs of the disease, in this case, before the arrival of the ambulance, you can provide the patient with first aid, and it is possible to save his life.

"Collapse" in translation into Russian means "fallen", in medical terminology collapse is a pathological condition that threatens the life of the patient, as a result of a drop in pressure in the arteries.

This phenomenon is caused by the following reasons:

1. Sharp and large blood loss, which leads to a decrease in blood mass.
2. Impact toxic substances, at which vascular walls lose their elasticity. For this reason, the overall tone of the circulatory system is reduced.

With collapse, there is a sharp hypoxia of all organs and systems human body, which occurs due to the lack of oxygen transported circulatory system. This process further reduces vascular tone, and, consequently, blood pressure, so the deterioration progresses.

The mechanisms that run all this pathological process may be as follows:

• bleeding - caused by both external and internal factors;
• poisoning with toxins;
• a sharp and rapid change in body position;
• lack of oxygen in the air;
• acute course of pancreatitis;
• dehydration;
• puberty;
• heatstroke;
• violation of cardiac activity - myocarditis, heart attack, pulmonary embolism, hemopericarditis.

provoke it critical situation maybe poisoning medications, severe fright, as well as adrenal dysfunction and anaphylactic shock.

Types of collapse

In medicine, collapse is classified according to the pathogenetic principle, but to a greater extent it is divided according to etiology, so we can say that collapse can be:

• Infectious-toxic - it is provoked by bacteria that call for infectious diseases.
• Toxic - develops for a reason general poisoning organism. To provoke a toxic collapse can be a person's activity associated with his professional affiliation, for example, when working with amino compounds, and so on.
• Hypoxemic - may develop with increased atmospheric pressure, as well as with a lack of oxygen in the air.
• Pancreatic - occurs with injuries or contusions of the pancreas.
• Burn - severe thermal skin damage.
• Hyperthermic - provokes severe overheating of the body or sunstroke.
• Dehydration - occurs as a result of dehydration of the body.
• Hemorrhagic - may occur with profuse bleeding. This condition is now called deep shock.
• Cardiogenic - develops as a result of the progression of cardiac ailments.
• Plasmorrhagic - develops due to the loss of plasma, which can be observed with a complicated form of diarrhea or with extensive burns in large quantities.
• Orthostatic - occurs with a rapid change in position human body from a supine position to an upright position. This phenomenon can be observed in patients leading a recumbent lifestyle. But also a collapse can occur with a long stay in vertical position, since in this case the venous blood flow increases, and the blood flow to the heart decreases. This phenomenon can be observed in adults healthy people as well as in childhood and adolescence.
• Enterogenic - can develop in people with gastric resection after eating.

collapse symptoms

In a state of collapse, there may be the following symptoms, which help to distinguish it from other seizures:

• there are sharp headaches;
• health deteriorates sharply and quickly;
• pupils become wide, vision becomes blurred, extraneous noises appear in the ears;
• uncharacteristic sensations appear in the cardiac region;
• weakness occurs;
• blood pressure quickly drops to critical levels;
• the skin turns pale, becomes wet and cold. After some time, cyanosis develops - the skin becomes bluish;
• the patient breathes superficially and rapidly;
• facial features are pointed;
• the pulse may not be palpable;
• body temperature drops;
• the patient loses consciousness.

Vascular collapse is less dangerous than cardiac collapse, however, if emergency care is delayed, in which case death may occur.

First aid

If you witnessed a collapse in a person, then your first action should be to call an ambulance. Then you need to very quickly provide the patient with immediate first aid. Ambulance and emergency care is very important, because without it a person can die before the arrival of doctors.

So, collapse and emergency care:

1. The patient should be put on his back and slightly raise his legs to ensure a rush of blood to the brain. Directly the very head of the patient must be turned to the side, especially if he is unconscious.
2. Next, you need to remove clothing from the patient, which can hamper breathing and blood supply.
3. The patient needs air, so you need to open a window and provide it with an influx or inhale oxygen.
4. Be sure to keep the patient warm. You can use heating pads or hot water bottles for this.
5. If the patient has lost consciousness, he must be revived with ammonia. If there is no ammonia at hand, then you need to massage the temples, the hole above the upper lip and the earlobes.
6. If the collapse occurred as a result of bleeding, then it must be fixed as soon as possible.
7. The patient must be at rest.

It is forbidden to give the patient medications, even heart medications. If the patient has lost consciousness, he should not be shaken, try to pour water or drops into his mouth.

Medical assistance

Oral administration of drugs in a state of collapse does not make sense. Only infusion into a vein can help, subcutaneous or muscle administration of drugs will be ineffective, since tissue circulation is disturbed and the absorption of drugs will be insufficient.

Medical emergency care consists in the administration of drugs that increase the volume of circulating blood, as well as drugs that increase blood pressure. Polyglucin and salt solutions are often used, for example, isotonic solution sodium chloride. However, with last drug must be respected exact dosage, since an overabundance of this drug can provoke pulmonary edema.

If the collapse happened as a result acute blood loss, then a blood transfusion is performed or fluids are administered to the patient, which are designed to provide blood replacement.

With a collapse of cardiogenic etiology, such measures are not carried out due to possible pulmonary edema. In this case, preference is given to pressor amines. The same measures are taken for anaphylactic collapse.

Noradrenaline influences blood vessels and cardiac activity. Dopamine has a vascular and selective effect. It not only constricts blood vessels, but also promotes expansion renal vessels and vessels leading to other organs.

Due to the fact that the collapse can be provoked different factors, in addition to vasoconstrictors, it is necessary to take all necessary measures to eliminate their effects on the body.

With hemorrhagic collapse, the main measure is to stop bleeding. For this, tamponade, tight dressings, and the use of tourniquets are used. Local anesthetics are also shown - novocaine blockades. If the collapse is caused by a burn or traumatic shock, then, as a rule, adrenal insufficiency occurs, in this case Hydrocortisone or Prednisolone is indicated.

Emergency medical care for infectious collapse is the use of antibacterial drugs.

Anaphylactic collapse should be treated not only with the introduction of colloidal or saline solutions, but also with Adrenaline, and, if necessary, glucocorticosteroids.

With hemolytic collapse, alkali solutions are introduced, and it is also necessary to warn acute insufficiency kidneys. All measures to provide emergency care to the patient are carried out with the absolute rest of the patient. When transporting a patient in an ambulance to intensive care unit, all urgent measures carried out in a vehicle.

collapse - acute vascular insufficiency- differs from fainting in the severity of manifestations and the duration of the course. Accompanied sharp drop arterial, venous pressure, a decrease in the volume of circulating blood, a minute volume of blood circulation, severe hypoxia, metabolic disorders, damage to the centers of the brain.

Occurs with intoxication infectious diseases, acute adrenal insufficiency, heart disease, etc. It can be combined with heart failure (often moderately severe) - mainly with myocardial infarction, with rapidly progressing acute myocarditis Consciousness is partially preserved. There are vascular, hemorrhagic collapse, cardiogenic hypotension.

Vascular collapse

It is characterized by a drop in vascular tone and an acute decrease in the volume of circulating blood. The inflow is decreasing venous blood to the heart, arterial and venous pressure decreases, the heart rate quickens.

hemorrhagic collapse

Cardiogenic hypotension

Symptoms

Pulse quickened, small filling, weak tension, sometimes threadlike; often difficult to determine. Heart sounds are muffled. Arterial pressure up to 40-50 mm Hg, is determined with difficulty. Body temperature is lowered. Possible vomiting.

In acute infectious diseases, a decrease in body temperature is prognostically unfavorable (may indicate the development of collapse)

Differentiate mainly with heart failure (Table 3)

Table 3 Differential Diagnosis vascular and heart failure

Urgent care

1. Complete rest. Strict bed rest. Warm (cover with a blanket, put heating pads) Hot strong tea, coffee.

2. Cordiamin - 0.5 ml, mezaton - 0.5 ml of a 1% solution intravenously, slowly.

When especially serious condition(vascular collapse, overdose drugs etc.), severe drug poisoning, analgesics, sleeping pills - cordiamine 2-4 ml, 5 ml intravenously, slowly; hydrocortisone - 100-150 mg intravenously; norepinephrine - 1-2 ml of a 0.2% solution in 250 ml of a 5% glucose solution intravenously, drip, up to 60 drops / min, under the control of blood pressure (up to 100-110 mm Hg)

Contraindications: cardiogenic shock, hemorrhagic, severe atherosclerosis, complete atrioventricular block; poisoning with chloroform, halothane, cyclopropane.

At less pronounced manifestations- cordiamin 1 ml, mezaton - 1 ml of a 1% solution subcutaneously or intramuscularly.

3. Camphor - 2-4 ml 20% oil solution subcutaneously. Caffeine - 1-2 ml of a 10% solution subcutaneously.

4. Strychnine - 1 ml of 0.1% solution subcutaneously. Analeptic solution (see page 23) 0.5-1 ml subcutaneously or intramuscularly.

5. Inhalation of a humidified oxygen-air mixture (40-60%) through a nasal catheter.

6. With severe intoxication - glucose up to 1 liter of 5% solution intravenously, drip (or isotonic sodium chloride solution)

7. With hemorrhagic collapse of blood transfusion (500-1000 ml), plasma substitutes (250-1000 ml)

8. When collapse is combined with heart failure, strophanthin - 0.25-0.5 ml of a 0.05% solution intravenously or corglicon - 0.5-1 ml of a 0.06% solution intravenously.

9. Treatment of the underlying disease. Symptomatic therapy.

10. Hospitalization after removal from the collapse. Transportation is gentle. Blood pressure control.

V.F. Bogoyavlensky, I.F. Bogoyavlensky

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

The reasons

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

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

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

Clinical picture

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

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

Help at the prehospital stage

When the first clinical signs the development of collapse in a child should immediately call an ambulance. Prior to the arrival of medical specialists, assistance is provided on prehospital stage which includes several events:

Further measures require intravenous or intramuscular injection medicines, which is carried out medical specialists already in the ambulance. After the child is hospitalized, care at the hospital stage necessarily includes an objective diagnosis of the causes of the collapse.